What the panel ordered
The Appeals Board granted the Petition for Reconsideration, rescinded the February 11, 2025 Findings and Order, and returned the matter to the trial level for further proceedings.
Applicant sought reconsideration of the WCJ's Findings and Order issued on February 11, 2025, which found no substantial medical evidence of industrial injury and ordered that applicant take nothing. The WCJ filed a Report and Recommendation to deny reconsideration. The Appeals Board granted reconsideration and rescinded the February 11, 2025 decision, returning the matter to the trial level for further proceedings.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Appeals Board found that the WCJ erred in relying on a QME's summary of subrosa video not in evidence to discredit applicant's credibility and that the medical evidence supported industrial injury. The matter was returned for further proceedings.
From the decision · page 1Applicant seeks reconsideration of the "Findings and Order and Opinion on Decision" (F&O) issued on February 11, 2025, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that the facts and medical evidence were irreconcilable in this case and found no substantial medical evidence proving industrial injury. The WCJ ordered that applicant take nothing on his claim.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
WCJ erred in relying on QME's summary of subrosa video not in evidence to discredit applicant's credibility.
Favours Applicant prevailed
This improper reliance led to denial of industrial injury claim, which was reversed on reconsideration.
From the decision · page 8Turning to the merits of the case, ordinarily we would give the WCJ's credibility determinations great weight because the WCJ had the opportunity to observe the demeanor of the witnesses. (Garza, supra, 3 Cal.3d at pp. 318-319.) However, in this case, the WCJ's Report discusses credibility in terms of the substance of applicant's testimony and not based upon the demeanor of the witnesses. Furthermore, it appears that the WCJ based her determinations of credibility upon the evaluator's review of subrosa film that is not in evidence. For the reasons discussed below, this is not proper.
QME Joseph Centeno found the right shoulder injury industrial and consistent with reported mechanism, supported by physical exam findings.
Favours Applicant prevailed
Supported applicant's claim of industrial injury despite subrosa video evidence.
From the decision · page 2Applicant was seen by QME Joseph Centeno, M.D., who authored four reports in evidence.
QME Centeno and PTP Nissen are in the same practice, creating a disqualifying conflict of interest for the QME.
Favours neutral
This conflict requires further development of the record at trial level.
From the decision · page 9In the initial QME report, according to the letterhead, Dr. Centeno appeared to be operating as a solo practitioner. In the next QME report, Dr. Centeno appears to have formed a practice with Teodoro Nissen, M.D., who is applicant's primary treating physician. Applicant testified at trial, which was summarized as follows:
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Found the right shoulder injury industrial and consistent with the reported mechanism of injury, supported by physical examination findings. Noted applicant's credible presentation and no non-physiological findings. Later noted subrosa video showed applicant working, but still found injury industrial.
The QME's medical opinion supported industrial causation despite subrosa video evidence, which the WCJ improperly used to discredit applicant's credibility.
From the decision · page 2Applicant was seen by QME Joseph Centeno, M.D., who authored four reports in evidence.
Primary treating physician who discussed injury and treatment with applicant, believed to share the same opinion as QME Centeno.
The QME and PTP are in the same practice, raising a conflict of interest issue for the QME.
From the decision · page 9In the initial QME report, according to the letterhead, Dr. Centeno appeared to be operating as a solo practitioner. In the next QME report, Dr. Centeno appears to have formed a practice with Teodoro Nissen, M.D., who is applicant's primary treating physician. Applicant testified at trial, which was summarized as follows:
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 3202.5, 3600(a), 5705; South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291
Applicant has the initial burden of proving industrial causation by showing employment was a contributing cause. Injury must occur in the course and arise out of employment. WCJ must state reasons for determination supported by substantial evidence.
Applied to evaluate industrial injury causation and credibility of evidence.
From the decision · page 7When applicant claims a physical injury, applicant has the initial burden of proving industrial causation by showing the employment was a contributing cause. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; § 5705.) Applicant must prove by a preponderance of the evidence that an injury occurred AOE/COE. (§ 3202.5; 3600(a).)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony and medical reports supporting industrial injury
From the decision · page 2Applicant was seen by QME Joseph Centeno, M.D., who authored four reports in evidence.
Subrosa video showing applicant working one day at a job site
From the decision · page 4Dr. Centeno was shown subrosa film of applicant working one day at a job site. (Joint Exhibit 104, Report of Joseph Centeno, M.D., August 28, 2024.) Dr. Centeno summarized his review of subrosa as follows:
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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