ADJ10801387 — California WCAB decision

What the panel ordered

Petition for Contribution filed by Hartford denied; July 9, 2019 Findings, Award and Order rescinded and substituted with denial of contribution.

Petition for Contribution filed by Hartford after settling applicant's claim; reconsideration granted to study factual and legal issues; decision after reconsideration issued.

Read the official decision →

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.

AOE/COEDefendant prevailedneck · arms · wrist · shoulders

The PQME's medical reports did not provide substantial medical evidence of an industrial injury; opinions were speculative and not framed in reasonable medical probability; Hartford failed to meet burden of proof for contribution liability.

From the decision · page 7In this case, the PQME's reports do not clearly articulate an opinion that applicant sustained an industrial injury and are not substantial medical evidence. In addition to speculating on what "it is medically possible to assume" and "the most plausible" diagnosis, Dr. Taghizadeh stated that "for the appropriate and accurate determination on causation, it would be appropriate to refer applicant to another specialty." (Exh. 1, p. 27.) To the extent the PQME opines that applicant sustained an industrial injury, that opinion is not supported and is beyond the range of his expertise. (Zemke, supra, at 801.)

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.

QMERejected · Chiropractic

Opined a possible causal relationship between work activities and injury, but opinions were speculative and not framed in reasonable medical probability; recommended referral to rheumatologist or internist for fibromyalgia evaluation.

The tribunal found the PQME's opinions speculative, not substantial medical evidence, and beyond his expertise regarding causation.

From the decision · page 7In this case, the PQME's reports do not clearly articulate an opinion that applicant sustained an industrial injury and are not substantial medical evidence. In addition to speculating on what "it is medically possible to assume" and "the most plausible" diagnosis, Dr. Taghizadeh stated that "for the appropriate and accurate determination on causation, it would be appropriate to refer applicant to another specialty." (Exh. 1, p. 27.) To the extent the PQME opines that applicant sustained an industrial injury, that opinion is not supported and is beyond the range of his expertise. (Zemke, supra, at 801.)

PTPNot reached

From the decision · page 7Here, multiple doctors, including the PQME examined applicant and documented her medical history. Applicant described repetitive job activities, including keyboarding, as part of her medical history. (Exh. 1, at p. 4; Hartford's Exh. 7, First Report of Injury, Dr. Danny Krygsman dated November 22, 2016 (exam November 18, 2016), at p. 1.) However, the PQME's opinion that those repetitive traumatic activities caused (or may have caused) an industrial injury is based on speculation, conjecture, and guess work. (Hegglin, supra, at 169; Zemke, supra, at 798; Escobedo, supra, at 620.) It is Dr. Taghizadeh's "considered opinion [that] to some degree that there is a causal relationship between the history of injury and the injury she sustained while performing her usual and customary work activities." (Exh. 1, at p. 26 [Emphasis in original].) Moreover, Dr. Taghizadeh's opinion is not framed in terms of reasonable medical probability, as probable requires more than a mere possibility. According to Dr.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Lab. Code, 3208.1; Lab. Code, 5500.5; Flesher v. Workers' Comp. Appeals Bd.; Greenwald v. Carey Dist. Co.; Peter Kiewit Sons v. Ind. Acc. Comm.; Insurance Company of North America v. Workers' Comp. Appeals Bd.; Escobedo v. Marshalls; Zemke v. Workers' Comp. Appeals Bd.; Hegglin v. Workmen's Comp. Appeals Bd.

A compensable injury may be specific or cumulative; cumulative injury is caused by repetitive traumatic activities over time (Lab. Code, 3208.1). Liability for cumulative injury claims is limited to employers during a defined period (Lab. Code, 5500.5). Contribution among insurers requires proof of liability (Lab. Code, 5500.5; Flesher; Greenwald). Medical evidence must be based on reasonable medical probability (Escobedo; Zemke; Hegglin).

The tribunal applied these standards to find that Hartford did not meet its burden to prove applicant sustained an industrial injury during EPIC's coverage period.

From the decision · page 4Under the workers' compensation statutes, a compensable injury may either be a "specific" injury or a "cumulative" injury. Labor Code section 3208.11 defines injury as either: "(a) `specific,' occurring as the result of one incident or exposure which causes disability or need for medical treatment; or (b) `cumulative,' occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment." (Lab. Code, 3208.1.) When an employee sustains a cumulative trauma injury, the employee may pursue their claim for benefits against any one or more of successive employers that employed the employee during the cumulative trauma. (Lab. Code, § 5500.5) If there are multiple employers during the 5500.5 liability period, the employers are jointly and severally liable for the entire award and may seek contribution from each other during separate proceedings. (Lab. Code, § 5500.5(e); Denny's Inc. v. Workers' Comp. Appeals Bd. (Bachman) (2003) 104 Cal. App. 4th1433 [68 Cal.Comp.Cases 1].)

ADJ10801387 · March 24, 2022

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page