ADJ16726116 — California WCAB decision

What the panel ordered

Findings and Order of March 13, 2025, rescinded; matter returned to trial level for further proceedings.

Petition for Reconsideration of the Findings and Order issued March 13, 2025, granted; WCJ's decision rescinded and matter returned for further proceedings.

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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.

AOE/COERemandedback

The WCJ's credibility determination was given great weight, but the PQME's opinion was found insufficiently supported due to incomplete record review and credibility issues, necessitating further development of the record and updated medical opinion.

From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

WCJ found applicant not credible due to contradicting statements and demeanor at trial.

Favours Defendant prevailed

This credibility finding influenced the initial denial of injury arising out of employment.

From the decision · page 4course of employment to her back. The WCJ ordered "[a]pplicant is to take nothing on her claim." In support, the WCJ stated in the Opinion on Decision, that "[a]pplicant was not credible. Her contradicting statements and her demeanor demonstrated to the Court that she was less than truthful during trial." (F&O, page 7.)

PQME rated applicant's credibility as moderate, indicating some doubt about applicant's statements.

Favours neutral

This affected the weight given to the PQME's opinion on industrial injury causation.

From the decision · page 3On May 4, 2023, PQME Dr. Ilkhchoui reported after the evaluation of applicant on February 3, 2023. The PQME reviewed and summarized treatment records from Kaiser covering the period before the alleged injury beginning June 25, 2020, to August 2, 2022, and after the alleged injury from August 9, 2022, to October 24, 2022. (Joint Exhibit 1, PQME Dr. Ilkhchoui, report of May 4, 2023, pages 7 to 18, pages 19 to 26.) Applicant was not at maximum medical improvement (MMI). He stated that: "I rate the applicant's credibility as moderate because she gave forth good effort during physical exam testing and was moderately accurate historian." He

PQME did not initially review all relevant Kaiser records, requiring further review and updated opinion.

Favours neutral

The incomplete record review necessitated remand for further development and updated medical opinion.

From the decision · page 4During deposition, the PQME did not recall seeing "a note at Page 386 through 389 of the Kaiser records" and stated it would be important for the PQME to look at them. (Joint Exhibit 2, Deposition of PQME Dr. Ilkchoui, MD, October 24, 2024, page 7, lines 9 to 25, page 8, lines 1 to 4.) The following exchange between counsel also occurred:

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Lab. Code, 3600

To be compensable, an injury must arise out of and occur in the course of employment.

The Appeals Board reviewed the evidence under this standard to determine compensability of the back injury.

From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

Lab. Code, 3202.5

The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence.

The Appeals Board applied this standard to assess the evidence presented by the applicant.

From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417

Medical evidence that industrial causation was reasonably probable constitutes substantial evidence for a finding of injury AOE/COE.

The Appeals Board considered this case law in evaluating the medical evidence for causation.

From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

ADJ16726116 · June 13, 2025

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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