ADJ17674030 · December 30, 2024

Dr. Haghighinia's reporting constituted substantial medical evidence, taking an accurate and adequate history and explaining how and why the industrial work exposure caused applicant's complaints. Minor report errors did not warrant rejection.

From the decision · page 7Here, lien claimant clearly met the burden of proving applicant's injury was industrial. Dr. Haghighinia's reporting constitutes substantial medical evidence by taking an accurate and adequate history of injury and explaining how and why the industrial work exposure caused applicant's complaints. The WCJ faulted the doctor for using an incorrect pronoun in one portion of the report, however this is a common error seen across many medical reports and does not, by itself, warrant rejecting the entirety of the report. The WCJ further noted that the doctor found that applicant had no flexion or extension range of motion measurements of the lumbar spine. This appears to be a misreading as the doctor placed an asterisk in these sections and noted that applicant was having pain in these areas. Again, this is a relatively minor issue that does not warrant rejecting the doctor's finding of industrial injury. Finally, the WCJ noted that the primary treater did not review applicant's prior medical records; however, there is no allegation that any such records exist, or were otherwise obtained and not reviewed.

Defendant deferred utilization review of the requests for authorization; reasonableness of treatment is deferred pending completion of UR/IMR process.

From the decision · page 7Next, the WCJ found that lien claimant did not meet their burden of proof as to the reasonableness and necessity of the treatment rendered. While this is technically true, it is only because defendant deferred conducting utilization review of the requests for authorization. Injury AOE/COE was a threshold issue in this case. Having resolved that issue in lien claimant's favor, defendant must now comply with regulation and conduct retrospective review of the deferred requests for authorization. Once the UR/IMR process is completed, the parties can review what treatment was reasonable and necessarily provided and attempt to resolve the remaining dispute.

Dr. Haghighinia's report provided an adequate history and explained industrial causation, and minor errors did not warrant rejection.

Favours Applicant prevailed

Supported finding of industrial injury (AOE/COE) in applicant's favor.

From the decision · page 7Here, lien claimant clearly met the burden of proving applicant's injury was industrial. Dr. Haghighinia's reporting constitutes substantial medical evidence by taking an accurate and adequate history of injury and explaining how and why the industrial work exposure caused applicant's complaints. The WCJ faulted the doctor for using an incorrect pronoun in one portion of the report, however this is a common error seen across many medical reports and does not, by itself, warrant rejecting the entirety of the report. The WCJ further noted that the doctor found that applicant had no flexion or extension range of motion measurements of the lumbar spine. This appears to be a misreading as the doctor placed an asterisk in these sections and noted that applicant was having pain in these areas. Again, this is a relatively minor issue that does not warrant rejecting the doctor's finding of industrial injury. Finally, the WCJ noted that the primary treater did not review applicant's prior medical records; however, there is no allegation that any such records exist, or were otherwise obtained and not reviewed.

Defendant deferred utilization review of treatment requests pending AOE/COE determination.

Favours neutral

Reasonableness of treatment could not be determined until UR/IMR process is completed; issue deferred.

From the decision · page 7Next, the WCJ found that lien claimant did not meet their burden of proof as to the reasonableness and necessity of the treatment rendered. While this is technically true, it is only because defendant deferred conducting utilization review of the requests for authorization. Injury AOE/COE was a threshold issue in this case. Having resolved that issue in lien claimant's favor, defendant must now comply with regulation and conduct retrospective review of the deferred requests for authorization. Once the UR/IMR process is completed, the parties can review what treatment was reasonable and necessarily provided and attempt to resolve the remaining dispute.

Diagnosed applicant with lumbar spine strain and bilateral knee tendonitis; opined with reasonable medical probability that pain and discomfort were due to work injury sustained while working for employer; report found to constitute substantial medical evidence supporting industrial causation.

Report took accurate and adequate history, explained industrial causation, and was not discredited by minor errors.

From the decision · page 7Here, lien claimant clearly met the burden of proving applicant's injury was industrial. Dr. Haghighinia's reporting constitutes substantial medical evidence by taking an accurate and adequate history of injury and explaining how and why the industrial work exposure caused applicant's complaints. The WCJ faulted the doctor for using an incorrect pronoun in one portion of the report, however this is a common error seen across many medical reports and does not, by itself, warrant rejecting the entirety of the report. The WCJ further noted that the doctor found that applicant had no flexion or extension range of motion measurements of the lumbar spine. This appears to be a misreading as the doctor placed an asterisk in these sections and noted that applicant was having pain in these areas. Again, this is a relatively minor issue that does not warrant rejecting the doctor's finding of industrial injury. Finally, the WCJ noted that the primary treater did not review applicant's prior medical records; however, there is no allegation that any such records exist, or were otherwise obtained and not reviewed.

South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; § 5705; §§ 3202.5, 3600(a)

Applicant has the initial burden of proving industrial causation by showing employment was a contributing cause; must prove by a preponderance of the evidence that an injury occurred AOE/COE.

Applied to find Dr. Haghighinia's report constituted substantial evidence of industrial injury.

From the decision · page 5When 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; § 5705.) Applicant must prove by a preponderance of the evidence that an injury occurred AOE/COE. ( § 3202.5; 3600(a).)

§§ 4600, 4610.5(c)(2); 5705

Lien claimant has the burden to prove that the treatment rendered was reasonable and necessary to cure or relieve from the effects of the industrial injury.

Applied to defer reasonableness of treatment pending completion of UR/IMR process.

From the decision · page 6Lien claimant has the burden to prove that the treatment rendered was reasonable and necessary to cure or relieve from the effects of the industrial injury. (§ 4600, 4610.5(c)(2); 5705.)

Dr. Haghighinia's report took an accurate and adequate history of injury and explained causation, overcoming minor report errors and lack of prior records.

From the decision · page 7Here, lien claimant clearly met the burden of proving applicant's injury was industrial. Dr. Haghighinia's reporting constitutes substantial medical evidence by taking an accurate and adequate history of injury and explaining how and why the industrial work exposure caused applicant's complaints. The WCJ faulted the doctor for using an incorrect pronoun in one portion of the report, however this is a common error seen across many medical reports and does not, by itself, warrant rejecting the entirety of the report. The WCJ further noted that the doctor found that applicant had no flexion or extension range of motion measurements of the lumbar spine. This appears to be a misreading as the doctor placed an asterisk in these sections and noted that applicant was having pain in these areas. Again, this is a relatively minor issue that does not warrant rejecting the doctor's finding of industrial injury. Finally, the WCJ noted that the primary treater did not review applicant's prior medical records; however, there is no allegation that any such records exist, or were otherwise obtained and not reviewed.