What the panel ordered
The WCAB affirmed the WCJ's November 17, 2021 Findings of Fact and Order, denying defendant's petition for reconsideration.
Defendant sought reconsideration of the WCJ's Findings of Fact and Order issued on November 17, 2021, which found additional industrial injury to applicant's left shoulder and chronic pain syndrome, after prior findings in 2014 did not include these injuries.
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 WCAB found that the issues of injury to the left shoulder and chronic pain syndrome were not barred by res judicata or collateral estoppel because they were not decided in prior proceedings and were supported by substantial medical evidence, including the QME report of Dr. Jeffrey Berman.
From the decision · page 4Based on the above discussion, we find no reasonable basis to disturb the WCJ's findings as to the body parts of the left shoulder and chronic pain syndrome based on the well-reasoned Qualified Medical Evaluator (QME) report of Jeffrey Berman, M.D., dated June 29, 2017.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The 2014 WCAB decision did not include findings or orders about injury to left shoulder or chronic pain syndrome, so these issues were not previously decided.
Favours Applicant prevailed
This allowed the WCJ to find injury to these body parts without being barred by res judicata or collateral estoppel.
From the decision · page 3Here, defendant has failed to meet its burden of proof regarding the third and fourth elements. The third element, that the issue must have been necessarily decided in the former proceeding, is not met because the October 23, 2014 Findings did not include findings or orders about applicant's body parts other than right shoulder, low back and psyche. Thus, the question of whether applicant sustained injury AOE/COE to body parts other than right shoulder, low back psyche was not "decided." Regarding the fourth element, the 2014 decision is final, but it did not address the merits of these specific claims of injury to applicant's left shoulder and in the form of chronic pain syndrome.
The medical evidence, including the QME report of Dr. Jeffrey Berman, supported injury to the left shoulder and chronic pain syndrome.
Favours Applicant prevailed
The WCAB relied on this evidence to affirm the finding of compensable injury to these body parts.
From the decision · page 4Based on the above discussion, we find no reasonable basis to disturb the WCJ's findings as to the body parts of the left shoulder and chronic pain syndrome based on the well-reasoned Qualified Medical Evaluator (QME) report of Jeffrey Berman, M.D., dated June 29, 2017.
The medical evidence from Dr. Alan Ross and Dr. Norman Namerow supported non-industrial causes for kidneys, diabetes, brain, sleep, and high blood pressure, rejecting industrial injury claims for those body parts.
Favours Defendant prevailed
This evidence led the WCAB to deny compensability for those conditions.
From the decision · page 11After an extensive and exhaustive review of the Exhibits in this matter, there did not appear to be any substantial medical evidence or testimonial evidence of any industrial injury to the applicant's teeth, jaw, or head. Additionally, based on the medical reporting of Defense orthopedic QME Lee Woods (Applicant Exhibit 14, Defense Exhibits A, B, BB-LL), Applicant's orthopedic QME Jeffrey Berman (Applicant's Exhibits 24 & 25) which were both well reasoned and persuasive, it also appeared that the applicant sustained an industrial injury to her left shoulder as well as chronic regional pain syndrome. In connection with the applicant's alleged injury to her kidneys, diabetes, brain, sleep, and high blood pressure, the Defense QME report in internal medicine from Alan Ross, M.D. (Defense Exhibits XX & YY) and the Defense QME reporting of Norman Namerow, M.D. (Defense Exhibit MM) were better reasoned and more persuasive.
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 that applicant sustained industrial injury to left shoulder and chronic regional pain syndrome, supported by well-reasoned and persuasive medical reports.
The WCAB relied on Dr. Berman's well-reasoned QME report dated June 29, 2017 to support the finding of injury to the left shoulder and chronic pain syndrome.
From the decision · page 4Based on the above discussion, we find no reasonable basis to disturb the WCJ's findings as to the body parts of the left shoulder and chronic pain syndrome based on the well-reasoned Qualified Medical Evaluator (QME) report of Jeffrey Berman, M.D., dated June 29, 2017.
Found no industrial injury to kidneys, diabetes, brain, sleep, and high blood pressure, attributing these conditions to non-industrial causes such as diabetes and diabetic neuropathy.
The WCAB found Dr. Ross's report more persuasive regarding non-industrial causes for certain conditions, rejecting industrial injury claims for those body parts.
From the decision · page 11After an extensive and exhaustive review of the Exhibits in this matter, there did not appear to be any substantial medical evidence or testimonial evidence of any industrial injury to the applicant's teeth, jaw, or head. Additionally, based on the medical reporting of Defense orthopedic QME Lee Woods (Applicant Exhibit 14, Defense Exhibits A, B, BB-LL), Applicant's orthopedic QME Jeffrey Berman (Applicant's Exhibits 24 & 25) which were both well reasoned and persuasive, it also appeared that the applicant sustained an industrial injury to her left shoulder as well as chronic regional pain syndrome. In connection with the applicant's alleged injury to her kidneys, diabetes, brain, sleep, and high blood pressure, the Defense QME report in internal medicine from Alan Ross, M.D. (Defense Exhibits XX & YY) and the Defense QME reporting of Norman Namerow, M.D. (Defense Exhibit MM) were better reasoned and more persuasive.
Agreed with Dr. Ross that industrial injury to kidneys, diabetes, brain, sleep, and high blood pressure was not sustained.
The WCAB found Dr. Namerow's report more persuasive regarding non-industrial causes for certain conditions, rejecting industrial injury claims for those body parts.
From the decision · page 11After an extensive and exhaustive review of the Exhibits in this matter, there did not appear to be any substantial medical evidence or testimonial evidence of any industrial injury to the applicant's teeth, jaw, or head. Additionally, based on the medical reporting of Defense orthopedic QME Lee Woods (Applicant Exhibit 14, Defense Exhibits A, B, BB-LL), Applicant's orthopedic QME Jeffrey Berman (Applicant's Exhibits 24 & 25) which were both well reasoned and persuasive, it also appeared that the applicant sustained an industrial injury to her left shoulder as well as chronic regional pain syndrome. In connection with the applicant's alleged injury to her kidneys, diabetes, brain, sleep, and high blood pressure, the Defense QME report in internal medicine from Alan Ross, M.D. (Defense Exhibits XX & YY) and the Defense QME reporting of Norman Namerow, M.D. (Defense Exhibit MM) were better reasoned and more persuasive.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code sections 5900, 5902, 5903; Rymer v. Hagler (1989) 211 Cal.App.3d 1171; Safeway Stores, Inc. v. Workers' Comp. Appeals Bd. (Pointer) (1980) 104 Cal.App.3d 528; Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Kramer) (1978) 82 Cal.App.3d 39; Maranian v. Workers' Comp. Appeals Bd. (2000) 81 Cal.App.4th 1068
A petition for reconsideration may only be taken from a final order, decision, or award that determines substantive rights or fundamental threshold issues.
The WCAB applied this standard to determine that the 2014 decision was final but did not address the merits of injury to left shoulder and chronic pain syndrome, allowing reconsideration.
From the decision · page 3A petition for reconsideration may properly be taken only from a "final" order, decision, or award. (Lab. Code, § 5900(a), 5902, 5903.) A "final" order has been defined as one that either "determines any substantive right or liability of those involved in the case" (Rymer v. Hagler (1989) 211 Cal.App.3d 1171, 1180; Safeway Stores, Inc. v. Workers' Comp. Appeals Bd. (Pointer) (1980) 104 Cal.App.3d 528, 534-535 [45 Cal.Comp.Cases 410]; Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Kramer) (1978) 82 Cal.App.3d 39, 45 [43 Cal.Comp.Cases 661]) or determines a "threshold" issue that is fundamental to the claim for benefits. (Maranian v. Workers' Comp. Appeals Bd. (2000) 81 Cal.App.4th 1068, 1070, 1075 [65 Cal.Comp.Cases 650].)
Labor Code section 5803; Meadows v. Bridgestone (2019); Davidson v. County of Sacramento Sheriff Dept. (2014); Crossley v. Fed. Express Corp. (2015); Shaw v. Automobile Club of Southern California (2023)
The WCAB has continuing jurisdiction under Labor Code section 5803 to enforce medical treatment awards more than five years after the date of injury, including compensable consequences of the original injury.
The WCAB applied this standard to find that injury to left shoulder and chronic pain syndrome related back to the original injury and were compensable consequences, not barred by limitations or res judicata.
What proof carried it
The evidence the panel weighed, by kind.
The medical record and QME reports of Dr. Jeffrey Berman supported injury to left shoulder and chronic pain syndrome.
From the decision · page 4Based on the above discussion, we find no reasonable basis to disturb the WCJ's findings as to the body parts of the left shoulder and chronic pain syndrome based on the well-reasoned Qualified Medical Evaluator (QME) report of Jeffrey Berman, M.D., dated June 29, 2017.
The medical record and QME reports of Dr. Alan Ross and Dr. Norman Namerow supported non-industrial causes for kidneys, diabetes, brain, sleep, and high blood pressure, favoring defendant.
From the decision · page 11After an extensive and exhaustive review of the Exhibits in this matter, there did not appear to be any substantial medical evidence or testimonial evidence of any industrial injury to the applicant's teeth, jaw, or head. Additionally, based on the medical reporting of Defense orthopedic QME Lee Woods (Applicant Exhibit 14, Defense Exhibits A, B, BB-LL), Applicant's orthopedic QME Jeffrey Berman (Applicant's Exhibits 24 & 25) which were both well reasoned and persuasive, it also appeared that the applicant sustained an industrial injury to her left shoulder as well as chronic regional pain syndrome. In connection with the applicant's alleged injury to her kidneys, diabetes, brain, sleep, and high blood pressure, the Defense QME report in internal medicine from Alan Ross, M.D. (Defense Exhibits XX & YY) and the Defense QME reporting of Norman Namerow, M.D. (Defense Exhibit MM) were better reasoned and more persuasive.
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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.
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