ADJ15734362 · October 9, 2023

The panel found that the applicant sustained injury to psyche, gastrointestinal system, headaches and bruxism arising out of and in the course of employment based on unrebutted medical expert opinions of PQME Dr. Egan and Dr. Daldalyan, supported by PTP Dr. Lamm and Dr. David, with causation apportioned primarily to workplace trauma and workload, and less than 25% to personnel actions, thus compensable under Labor Code Section 3208.3(h).

From the decision · page 5Based on the unrebutted medical expert opinions of Panel Qualified Medical Evaluator (PQME) Linslee Egan, M.D. in psychiatry and of PQME Kouron Daldalyan in internal medicine, which are further supported by the expert opinions of Primary Treating Physician (PTP) Marcia Lamm, Ph.D. and Vera David, Ph.D. in psychology, it was found that applicant sustained injury arising out of and in the course of employment to her psyche, gastrointestinal system, and in the form of headaches and bruxism. Dr. Egan diagnosed PTSD, with a GAF of 55, not yet at maximal medical improvement (MMI), causing temporary disability from January 7, 2022 and ongoing. Dr. Egan's causation

Unrebutted medical expert opinions of PQME Dr. Egan and Dr. Daldalyan supported injury causation to psyche, gastrointestinal system, headaches and bruxism.

Favours Applicant prevailed

These opinions formed the basis for the panel's finding of compensable injury and entitlement to temporary disability and medical treatment.

From the decision · page 5Based on the unrebutted medical expert opinions of Panel Qualified Medical Evaluator (PQME) Linslee Egan, M.D. in psychiatry and of PQME Kouron Daldalyan in internal medicine, which are further supported by the expert opinions of Primary Treating Physician (PTP) Marcia Lamm, Ph.D. and Vera David, Ph.D. in psychology, it was found that applicant sustained injury arising out of and in the course of employment to her psyche, gastrointestinal system, and in the form of headaches and bruxism. Dr. Egan diagnosed PTSD, with a GAF of 55, not yet at maximal medical improvement (MMI), causing temporary disability from January 7, 2022 and ongoing. Dr. Egan's causation

Defendant failed to provide required advance notice of sending over 1,600 pages of Kaiser records to PQME Dr. Egan until nine days before trial, violating Labor Code Section 4062.3(b).

Favours Applicant prevailed

This procedural violation led to exclusion of supplemental report and supported denial of defendant's petition for reconsideration.

From the decision · page 12(Opinion on Decision, 7/17/2023, pp. 5-6.) As also noted in the preceding section of this report, Dr, Egan did not change her opinions at cross examination, and she did not indicate that review of applicant's Kaiser records was required. Defendant initially chose not to send to Dr. Egan over 1,600 pages of Kaiser records, which it clearly had in its possession, ostensibly to save money on review of records under the current medical-legal fee schedule. After defendant had Dr Egan's report, it failed to pursue review of the omitted records for the better part of a year, when it unilaterally sent this information to the QME nine days before trial, without providing advance notice to applicant as required by Labor Code Section 4062.3(b). Dr. Egan concluded the deposition by stating only that she "would welcome" any additional records (Deposition of Dr. Egan 5/16/2023, Joint 2, p. 21, L 17- 20). For this reason, the cross examination of Dr. Egan was not regarded as requiring a supplemental report with review of records.

Diagnosed PTSD with GAF of 55, causation analysis attributing 55% to workplace trauma, 25% to workload, 10% to poor coping skills, and less than 25% to personnel actions, supporting compensable psychiatric injury.

Unrebutted medical expert opinion accepted by the panel as basis for injury causation and disability findings.

From the decision · page 5Based on the unrebutted medical expert opinions of Panel Qualified Medical Evaluator (PQME) Linslee Egan, M.D. in psychiatry and of PQME Kouron Daldalyan in internal medicine, which are further supported by the expert opinions of Primary Treating Physician (PTP) Marcia Lamm, Ph.D. and Vera David, Ph.D. in psychology, it was found that applicant sustained injury arising out of and in the course of employment to her psyche, gastrointestinal system, and in the form of headaches and bruxism. Dr. Egan diagnosed PTSD, with a GAF of 55, not yet at maximal medical improvement (MMI), causing temporary disability from January 7, 2022 and ongoing. Dr. Egan's causation

Found temporary disability from January 13, 2022 to April 20, 2022, causation opinions consistent with Dr. Egan, apportioned some disability to preexisting conditions but found them sequelae of psyche injury.

Unrebutted medical expert opinion supporting injury causation and disability, consistent with Dr. Egan's psychiatric findings.

Supported injury findings and need for further psychological treatment.

Supporting expert opinion consistent with PQME opinions.

From the decision · page 7Based on the unrebutted medical expert opinion of PQME Dr. Egan, M.D. in psychiatry and PQME Dr. Daldalyan in internal medicine, as further supported by the expert opinions of PTP Dr. Lamm and Dr. David in psychology, it was found that further medical treatment is required to cure or relieve the effects of the injury, including but not limited to the specific provisions of PQME Dr. Daldalyan for further psychological treatment and consultations regarding further treatment with a gastroenterologist, a neurologist, and a dentist. It is found that the psychological treatment should be with current PTP Marcia Lamm, Ph.D. or any other psychologist of applicant's choice, and consultations regarding further treatment with a gastroenterologist, a neurologist, and a dentist should also be with physicians of applicant's choice.

Supported injury findings and need for further psychological treatment.

Supporting expert opinion consistent with PQME opinions.

From the decision · page 7Based on the unrebutted medical expert opinion of PQME Dr. Egan, M.D. in psychiatry and PQME Dr. Daldalyan in internal medicine, as further supported by the expert opinions of PTP Dr. Lamm and Dr. David in psychology, it was found that further medical treatment is required to cure or relieve the effects of the injury, including but not limited to the specific provisions of PQME Dr. Daldalyan for further psychological treatment and consultations regarding further treatment with a gastroenterologist, a neurologist, and a dentist. It is found that the psychological treatment should be with current PTP Marcia Lamm, Ph.D. or any other psychologist of applicant's choice, and consultations regarding further treatment with a gastroenterologist, a neurologist, and a dentist should also be with physicians of applicant's choice.

California Labor Code

Labor Code Section 3208.3

Applied to determine compensability of psychiatric injury based on causation analysis.

From the decision · page 6analysis complied with the requirements of Labor Code Section 3208.3 and Rolda v. Pitney Bowes (2001) 66 Cal.Comp.Cases 241 (Appeals Board en banc) by finding that actual events of employment were the predominant cause of applicant's psychiatric injury, with 55% of injury caused by workplace trauma working with homeless people on the streets of Los Angeles, 25% of injury caused by excessive workload, which Dr. Egan noted may be by perceived or actual, 10% of injury caused by poor coping skills and impaired distress tolerance. As the trier of fact, the undersigned accepted all of the events described by applicant in Dr. Egan's report as actual events and not figments of her imagination. Of the causes of injury identified by Dr. Egan, only the 10% attributed to the employer's lack of support or mistreatment would constitute personnel actions, and since the percentage of causation attributed to this factor is less than 25%, it is not a substantial cause of injury to the psyche that would bar a finding of compensable injury to the psyche under Labor Code Section 3208.3(h).

California Labor Code

Labor Code Section 4062.3(b)

Applied to exclude improperly obtained supplemental report due to failure to provide required advance notice of records sent to PQME.

From the decision · page 12(Opinion on Decision, 7/17/2023, pp. 5-6.) As also noted in the preceding section of this report, Dr, Egan did not change her opinions at cross examination, and she did not indicate that review of applicant's Kaiser records was required. Defendant initially chose not to send to Dr. Egan over 1,600 pages of Kaiser records, which it clearly had in its possession, ostensibly to save money on review of records under the current medical-legal fee schedule. After defendant had Dr Egan's report, it failed to pursue review of the omitted records for the better part of a year, when it unilaterally sent this information to the QME nine days before trial, without providing advance notice to applicant as required by Labor Code Section 4062.3(b). Dr. Egan concluded the deposition by stating only that she "would welcome" any additional records (Deposition of Dr. Egan 5/16/2023, Joint 2, p. 21, L 17- 20). For this reason, the cross examination of Dr. Egan was not regarded as requiring a supplemental report with review of records.

California Labor Code

Labor Code Section 5502(d)(3)

Applied to exclude evidence obtained after discovery cutoff unless due diligence shown.

From the decision · page 13Labor Code Section 5502(d)(3), cited in defendant's petition, provides that "[d]iscovery shall close on the date of the mandatory settlement conference. Evidence not disclosed or obtained thereafter shall not be admissible unless the proponent of the evidence can demonstrate that it was not available or could not have been discovered by the exercise of due diligence prior to the settlement conference." The supplemental report of Dr. Egan reviewing Kaiser records and Dr. Daldalyan's opinions, including his April 20, 2022 report, could easily have been obtained by defendants in 2022 by the exercise of due diligence. Accordingly, Section 5502(d)(3) requires the exclusion of Dr. Egan's supplemental report.

Defendant failed to send over 1,600 pages of Kaiser records to PQME Dr. Egan until nine days before trial, without 20 days' advance notice as required by Labor Code Section 4062.3(b).

From the decision · page 12(Opinion on Decision, 7/17/2023, pp. 5-6.) As also noted in the preceding section of this report, Dr, Egan did not change her opinions at cross examination, and she did not indicate that review of applicant's Kaiser records was required. Defendant initially chose not to send to Dr. Egan over 1,600 pages of Kaiser records, which it clearly had in its possession, ostensibly to save money on review of records under the current medical-legal fee schedule. After defendant had Dr Egan's report, it failed to pursue review of the omitted records for the better part of a year, when it unilaterally sent this information to the QME nine days before trial, without providing advance notice to applicant as required by Labor Code Section 4062.3(b). Dr. Egan concluded the deposition by stating only that she "would welcome" any additional records (Deposition of Dr. Egan 5/16/2023, Joint 2, p. 21, L 17- 20). For this reason, the cross examination of Dr. Egan was not regarded as requiring a supplemental report with review of records.