What the panel ordered
The WCAB rescinded the December 27, 2021 WCJ Findings and substituted new Findings that the parties did not agree to submit medical treatment disputes to Dr. Siebold, deferring all other issues.
Defendant seeks reconsideration of the Findings of Fact and Award issued on December 27, 2021, by the WCJ, which found that issues of medical treatment shall be resolved by Dr. Richard Siebold per the original stipulation of the parties.
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 plain language of the 2003 Stipulations did not show mutual agreement to submit future medical treatment disputes to Dr. Siebold, and there was no evidence to bypass the statutory utilization review and independent medical review processes.
From the decision · page 5Here, the Stipulations clearly state in Paragraph 4 that: "There is need for medical treatment to cure or relieve from the effects of said injury pursuant to the AME reports of Richard Siebold, M.D." This is a statement that applicant will require medical treatment based on the current opinion of Dr. Siebold; the stipulation does not state that all future medical treatment issues shall be decided by Dr. Siebold. In addition in Paragraph 8, stipulation 2 states that: "The parties stipulate to the findings of the AME Richard Siebold, MD." This appears to be more likely to be an agreement as to Dr. Siebold's opinion as to applicant's permanent disability, and not a statement that disputes regarding medical treatment would be submitted to Dr. Siebold in the future. Thus, based on the plain language of the Stipulations, we do not find that the parties meant to submit their disputes regarding medical treatment to Dr. Siebold.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The 2003 Stipulations' language did not show mutual consent to submit future medical treatment disputes to Dr. Siebold.
Favours Defendant prevailed
This lack of mutual consent meant the parties did not agree to bypass statutory medical treatment dispute processes, leading to rescission of prior Findings.
From the decision · page 5Here, the Stipulations clearly state in Paragraph 4 that: "There is need for medical treatment to cure or relieve from the effects of said injury pursuant to the AME reports of Richard Siebold, M.D." This is a statement that applicant will require medical treatment based on the current opinion of Dr. Siebold; the stipulation does not state that all future medical treatment issues shall be decided by Dr. Siebold. In addition in Paragraph 8, stipulation 2 states that: "The parties stipulate to the findings of the AME Richard Siebold, MD." This appears to be more likely to be an agreement as to Dr. Siebold's opinion as to applicant's permanent disability, and not a statement that disputes regarding medical treatment would be submitted to Dr. Siebold in the future. Thus, based on the plain language of the Stipulations, we do not find that the parties meant to submit their disputes regarding medical treatment to Dr. Siebold.
No evidence existed that parties intended to bypass utilization review and independent medical review processes established after the 2003 Stipulations.
Favours Defendant prevailed
Without such evidence, the statutory processes remain the proper mechanism for medical treatment disputes, supporting the new Findings.
From the decision · page 5Moreover, there is no evidence that the parties ever intended to bypass the UR and IMR processes given that the parties drafted their Stipulations prior to the institution of UR in 2004 and IMR in 2013. While we note that the parties had previously forwarded prior medical treatment disputes to Dr. Siebold for resolution, those prior acts do not change the outcome because they do not represent a broad agreement to submit all medical treatment disputes to Dr. Siebold.
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.
AME reports were referenced in the 2003 Stipulations regarding medical treatment needs and permanent disability findings.
The stipulations referenced Dr. Siebold's AME reports for medical treatment and permanent disability findings, but did not establish control over future medical treatment disputes.
From the decision · page 2Applicant, while employed by defendant as an assembly line worker on March 9, 2000, sustained an industrial injury to his back, left hip and leg. The parties entered into Stipulations, dated July 28, 2003, for 81% permanent disability. In Paragraph 4 of the Stipulations, the parties agreed that: "There is a need for medical treatment to cure or relieve from the effects of said injury pursuant to the AME reports of Richard Siebold, MD." In Paragraph 8, stipulation 2, they agreed that: "The parties stipulate to the findings of the AME Richard Siebold, MD."
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4600
Labor Code section 4600 requires provision of medical treatment reasonably required to cure or relieve effects of injury.
Applied to determine the scope of medical treatment obligations.
From the decision · page 3Section 4600 requires a defendant to provide medical treatment "reasonably required to cure or relieve the injured worker from the effects of his or her injury" if there is a medical recommendation or prescription that there is a "demonstrated medical need" for such services. (Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36 [49 Cal.Comp.Cases 454].) Section 4600(h) further provides that home health care services are medical treatment, but they must be prescribed by a physician.
Labor Code section 4600(h)
Labor Code section 4600(h) provides that home health care services are medical treatment and must be prescribed by a physician.
Applied to issues regarding home health care.
From the decision · page 3Section 4600 requires a defendant to provide medical treatment "reasonably required to cure or relieve the injured worker from the effects of his or her injury" if there is a medical recommendation or prescription that there is a "demonstrated medical need" for such services. (Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36 [49 Cal.Comp.Cases 454].) Section 4600(h) further provides that home health care services are medical treatment, but they must be prescribed by a physician.
Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc)
Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc) outlines principles for medical treatment disputes and utilization review.
Applied to analyze jurisdiction over medical treatment disputes.
From the decision · page 3With respect to WCAB jurisdiction over medical treatment disputes, pursuant to Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc) (Dubon II), we articulated the following principles regarding disputes regarding medical treatment:
What proof carried it
The evidence the panel weighed, by kind.
The plain language of the 2003 Stipulations did not indicate an agreement to submit future medical treatment disputes to Dr. Siebold.
From the decision · page 5Here, the Stipulations clearly state in Paragraph 4 that: "There is need for medical treatment to cure or relieve from the effects of said injury pursuant to the AME reports of Richard Siebold, M.D." This is a statement that applicant will require medical treatment based on the current opinion of Dr. Siebold; the stipulation does not state that all future medical treatment issues shall be decided by Dr. Siebold. In addition in Paragraph 8, stipulation 2 states that: "The parties stipulate to the findings of the AME Richard Siebold, MD." This appears to be more likely to be an agreement as to Dr. Siebold's opinion as to applicant's permanent disability, and not a statement that disputes regarding medical treatment would be submitted to Dr. Siebold in the future. Thus, based on the plain language of the Stipulations, we do not find that the parties meant to submit their disputes regarding medical treatment to Dr. Siebold.
No evidence that parties intended to bypass the utilization review and independent medical review processes, which were instituted after the 2003 Stipulations.
From the decision · page 5Moreover, there is no evidence that the parties ever intended to bypass the UR and IMR processes given that the parties drafted their Stipulations prior to the institution of UR in 2004 and IMR in 2013. While we note that the parties had previously forwarded prior medical treatment disputes to Dr. Siebold for resolution, those prior acts do not change the outcome because they do not represent a broad agreement to submit all medical treatment disputes to Dr. Siebold.
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