What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed subsequent to Findings and Award issued on November 27, 2024
This docket was decided more than once. Shown here is the latest released decision; we also hold April 16, 2021.
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 Appeals Board acted timely on the petition for reconsideration within the 60-day period from transmission of the case and found no basis to grant reconsideration.
From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the Report of the workers' compensation administrative law judge (WCJ) with respect thereto.1 Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, we will deny reconsideration.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The case was transmitted to the Appeals Board on December 24, 2024, and the petition was acted upon within the 60-day period ending February 24, 2025.
Favours Defendant prevailed
This timely action satisfied the requirements of Labor Code section 5909, leading to denial of the petition for reconsideration.
From the decision · page 2Here, according to Events, the case was transmitted to the Appeals Board on December 24, 2024, and 60 days from the date of transmission is Saturday, February 22, 2025. The next business day that is 60 days from the date of transmission is Monday, February 24, 2025. (See Cal. Code Regs., tit. 8, § 10600(b).) This decision is issued by or on Monday, February 24, 2025, so that we have timely acted on the petition as required by section 5909(a).
Defendant timely sent deferral notices disputing liability for dental/TMJ treatment, complying with Labor Code section 4610(l) and regulation 9792.9.1(b).
Favours Defendant prevailed
This justified the utilization review deferral and supported denial of the petition for reconsideration.
From the decision · page 6Although Applicant contends the deferral notices here are defective and inadequate, and therefore inapplicable, the items admitted into evidence show that on January 8, 2024 a deferral notice in compliance with section 4610 and regulation 9792.9.1(b) was sent by Defendant to Dr. Tran within 4 days of receipt of his RFA for dental treatment. The deferral notice listed the physician's treatment recommendations and indicated that "dental" was an unlisted body part. The other required notices were included and copies of the deferral were sent to Applicant and her attorney, among others [See Ex K].
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.
Thought Applicant had a repetitive motion injury involving neck and back progressing to TMJ/myofascial pain disorder, but opinion undermined by lack of supporting factual evidence.
Lack of supporting factual evidence and credibility issues led to rejection of this opinion regarding liability for TMJ/dental problems.
From the decision · page 7Dr. Rosenson thought that Applicant had a repetitive motion injury involving her neck as well as her back [Ex 53, P1] and that the cervical trauma progressed to "a temporomandibular joint/myofascial pain disorder" [Ex 53, P5]. This opinion concerning a relationship between Applicant's back injury and her TMJ/dental issues was undermined by lack of supporting factual evidence:
Attributed TMJ/dental problems to direct work-related traumas to head, but opinion was discounted due to lack of history of repetitive trauma and credibility issues with testimony.
Credibility issues with Applicant's testimony and lack of history of repetitive trauma led to disinclination to rely on this opinion.
From the decision · page 8The PQME, Dr. Hagstrom, issued a report in July 2014 in which he blamed the TMJ/dental problems on "direct result of several work related direct traumas. The onset of symptoms corresponds directly with the description of the direct impact to the head and face with a traumatic blow to the head. She reports no other previous medical conditions or injuries." [Ex 67, P17]
Explained TMJ/dental problems as a compensable consequence of back pain leading to teeth grinding; this opinion was relied upon by the Court.
The Court found this opinion more plausible and consistent with Applicant's testimony, relying on it to find compensability.
From the decision · page 8The third report, by Dr. Tran, explained that Applicant has back pain and that this pain leads to grinding of teeth, which then leads to the TMJ/dental problems of the type from which Applicant suffers [Ex 64, P5]. This was a more plausible explanation consistent with Applicant's testimony. The Court relied on this opinion to find that the TMJ/dental problems are in fact a compensable consequence of the Applicant's cumulative back injury.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 5909
Labor Code section 5909
The Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board.
From the decision · page 1We note that former Labor Code2 section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that:
Cal. Code Regs., tit. 8, 10600(b)
Cal. Code Regs., tit. 8, 10600(b)
The next business day after 60 days from transmission is the deadline for the Appeals Board to act on the petition.
From the decision · page 2Here, according to Events, the case was transmitted to the Appeals Board on December 24, 2024, and 60 days from the date of transmission is Saturday, February 22, 2025. The next business day that is 60 days from the date of transmission is Monday, February 24, 2025. (See Cal. Code Regs., tit. 8, § 10600(b).) This decision is issued by or on Monday, February 24, 2025, so that we have timely acted on the petition as required by section 5909(a).
What proof carried it
The evidence the panel weighed, by kind.
Credibility issues with Applicant's testimony about head trauma incidents
From the decision · page 8However, this is a continuing trauma case and there is no history in the rather lengthy medical Record of repetitive trauma to Applicant's head. Applicant did testify at the hearing on 10/8/24 to once bumping her head while walking near a machine, and to being struck on the head once while working with a training customer [10/8/24 SOE, P4, L15-18]. However, there is a bit of a credibility issue with respect to this testimony inasmuch as these incidents were never reported as injury events to any physician treating or evaluating Applicant. Moreover, these are two specific traumatic incidents, not a "cumulative" trauma. Consequently, the Court was disinclined to rely on Dr. Hagstrom's opinion on causation here, and could understand why Defendant would not.
Lack of supporting factual evidence for Dr. Rosenson's opinion on neck injury
From the decision · page 7Dr. Rosenson thought that Applicant had a repetitive motion injury involving her neck as well as her back [Ex 53, P1] and that the cervical trauma progressed to "a temporomandibular joint/myofascial pain disorder" [Ex 53, P5]. This opinion concerning a relationship between Applicant's back injury and her TMJ/dental issues was undermined by lack of supporting factual evidence:
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About this page
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