What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed by applicant after trial decision denying industrial injury claim
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 WCJ and WCAB found that the medical reports of PQME Dr. Wantuch were not substantial evidence to support the claim, while Dr. Bates's reports were substantial and well-reasoned, showing the injury was due to pre-existing bipolar disorder, not industrial injury.
From the decision · page 2For the reasons stated in the WCJ's Report, the medical reports and testimony of PQME Dr. Wantuch were not substantial evidence to support applicant's claim of industrial injury. Accordingly, we deny applicant's petition for reconsideration.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Wantuch's medical reports were inconsistent, confusing apportionment and causation, and lacked explanation for changes in opinion.
Favours Defendant prevailed
This undermined the credibility and substantiality of the medical evidence supporting the applicant's claim, leading to denial of the petition.
From the decision · page 5Wantuch states that she cannot apportion permanent disability to applicant's bipolar disorder because applicant was able to perform her job and take care of her cats. (Exhibit 10 p.5) In her next report, Dr. Wantuch notes that she apportioned 35% of applicant's disability to applicant's personality traits. (Exhibit 6 p. 2) In her next report Dr. Wantuch stated that applicant's disability was 100% related to applicant's industrial injury. (Exhibit 9 p.1). In her last report Dr. Wantuch apportions 15% of applicant's injury to personnel actions and 10% to applicant's psychiatric history. (Exhibit 4 p. 3). Dr. Wantuch continually confused apportionment of permanent disability and causation of injury. Dr. Wantuch also provided different levels of apportionment/causation in just about every report without explanation as to why she changed her opinion. As originally discussed with the parties at the November 22, 2021, Trial Dr. Wantuch's reporting is not substantial medical evidence for these reasons.
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.
Dr. Wantuch's medical reports were found not to be substantial evidence due to inconsistent apportionment and causation opinions and lack of explanation for changes in opinion.
The reports showed inconsistent apportionment and causation opinions without explanation, confusing permanent disability apportionment and causation, and thus were not substantial evidence.
From the decision · page 2For the reasons stated in the WCJ's Report, the medical reports and testimony of PQME Dr. Wantuch were not substantial evidence to support applicant's claim of industrial injury. Accordingly, we deny applicant's petition for reconsideration.
Dr. Bates provided substantial medical evidence with a well-reasoned causation analysis, opining the psychiatric injury was due to pre-existing bipolar disorder.
Dr. Bates's report was found substantial and well-reasoned, supporting non-industrial causation due to pre-existing bipolar disorder.
From the decision · page 4Dr. Bates provided reporting which included an extensive history of the injury as told by the applicant. (Exhibit A p. 6-8) The report discusses the incident where applicant missed the interview for a promotional opportunity and the effect that this had on applicant's life. Dr. Bates also took an occupational history, past psychiatric history, substance abuse history, past medical history, family psychiatric history, and social history from the applicant and reviewed records. (Exhibit A p.6-11) As noted in the Opinion on Decision, Dr. Bates provided substantial medical evidence and provided a well-reasoned causation analysis. In particular, Dr. Bates opined that applicant's psychiatric injury was due to her pre-existing bipolar disorder.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291
The employee bears the burden of proving the injury arose out of and in the course of employment by a preponderance of the evidence.
Applied to determine compensability of the injury claim.
From the decision · page 1The employee bears the burden of proving the injury arose out of and in the course of employment by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a), 3202.5.)
Lab. Code, 5952(d)
A WCJ's decision must be supported by substantial evidence in light of the entire record.
Applied to evaluate the sufficiency of medical evidence supporting the claim.
From the decision · page 1Further, a WCJ's decision must be supported by substantial evidence in light of the entire record. (Lab. Code, § 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310];Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635 [35 Cal.Comp.Cases 16].) "The term `substantial evidence' means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion...It must be reasonable in nature, credible, and of solid value." (Braewood Convalescent Hosp. v. Workers' Comp. Appeals
Lab. Code, 4060(c)(d), 4061(i), 4062.3(l)
Medical evidence is required if there is an issue regarding the compensability of the claim. A medical opinion must be framed in terms of reasonable medical probability, based on an adequate examination and history, not speculative, and must set forth reasoning to support conclusions.
Applied to assess the quality and sufficiency of medical opinions in the case.
From the decision · page 2Medical evidence is required if there is an issue regarding the compensability of the claim. (Lab. Code, § 4060(c)(d), 4061(i), 4062.3(l).) A medical opinion must be framed in terms of reasonable medical probability, it must be based on an adequate examination and history, it must not be speculative, and it must set forth reasoning to support the expert conclusions reached. (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 620-621 (Appeals Bd. en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
What proof carried it
The evidence the panel weighed, by kind.
Inconsistent and unexplained changes in Dr. Wantuch's apportionment and causation opinions
From the decision · page 5Wantuch states that she cannot apportion permanent disability to applicant's bipolar disorder because applicant was able to perform her job and take care of her cats. (Exhibit 10 p.5) In her next report, Dr. Wantuch notes that she apportioned 35% of applicant's disability to applicant's personality traits. (Exhibit 6 p. 2) In her next report Dr. Wantuch stated that applicant's disability was 100% related to applicant's industrial injury. (Exhibit 9 p.1). In her last report Dr. Wantuch apportions 15% of applicant's injury to personnel actions and 10% to applicant's psychiatric history. (Exhibit 4 p. 3). Dr. Wantuch continually confused apportionment of permanent disability and causation of injury. Dr. Wantuch also provided different levels of apportionment/causation in just about every report without explanation as to why she changed her opinion. As originally discussed with the parties at the November 22, 2021, Trial Dr. Wantuch's reporting is not substantial medical evidence for these reasons.
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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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