ADJ11645837 — California WCAB decision

What the panel ordered

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and upheld the WCJ's findings and awards.

Defendant sought reconsideration of the January 21, 2025 Joint Findings of Fact, Order and Award (FO&A) by the WCJ, which found injury arising out of and in the course of employment (AOE/COE) and awarded retroactive temporary disability and permanent disability.

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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/COEApplicant prevailedcervical spine · lumbar spine · bilateral shoulders · right hand · psyche · fibromyalgia · gastritis · IBS · migraines · dermatitis

The WCJ's findings of injury AOE/COE to multiple body parts were supported by substantial medical evidence from multiple physicians and QMEs, including Drs. Hannani, Edelman, and Zlotolow, whose reports were found to be credible and based on reasonable medical probability.

From the decision · page 1Defendant seeks reconsideration of the January 21, 2025 Joint Findings of Fact, Order and Award (FO&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a senior insurance examiner/financial analyst by defendant during the period from October 19, 2017 through October 19, 2018 (ADJ11645837), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, migraines, and dermatitis. The WCJ also found injury AOE/COE on October 25, 2018 (ADJ11645835) to the overlapping body parts of the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, and migraines. The WCJ awarded retroactive temporary disability from July 20, 2019, through September 2, 2020, for the cumulative injury (less credit for prior temporary disability or ILD payments for the same period), as well as permanent disability based upon combined impairment from both injuries.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The reports of Drs. Hannani, Edelman, and Zlotolow were relied upon by the WCJ as substantial medical evidence supporting injury AOE/COE and impairment.

Favours Applicant prevailed

These reports provided the medical basis for the WCJ's findings and awards, which the Appeals Board upheld.

From the decision · page 1Defendant seeks reconsideration of the January 21, 2025 Joint Findings of Fact, Order and Award (FO&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a senior insurance examiner/financial analyst by defendant during the period from October 19, 2017 through October 19, 2018 (ADJ11645837), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, migraines, and dermatitis. The WCJ also found injury AOE/COE on October 25, 2018 (ADJ11645835) to the overlapping body parts of the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, and migraines. The WCJ awarded retroactive temporary disability from July 20, 2019, through September 2, 2020, for the cumulative injury (less credit for prior temporary disability or ILD payments for the same period), as well as permanent disability based upon combined impairment from both injuries.

Applicant was determined to be temporarily totally disabled from July 20, 2019 through September 2, 2020.

Favours Applicant prevailed

This supported the WCJ's award of retroactive temporary disability, which the Appeals Board found no conflict with prior orders.

From the decision · page 1Defendant seeks reconsideration of the January 21, 2025 Joint Findings of Fact, Order and Award (FO&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a senior insurance examiner/financial analyst by defendant during the period from October 19, 2017 through October 19, 2018 (ADJ11645837), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, migraines, and dermatitis. The WCJ also found injury AOE/COE on October 25, 2018 (ADJ11645835) to the overlapping body parts of the cervical and lumbar spine, bilateral shoulders, right hand, psyche, fibromyalgia, gastritis, IBS, and migraines. The WCJ awarded retroactive temporary disability from July 20, 2019, through September 2, 2020, for the cumulative injury (less credit for prior temporary disability or ILD payments for the same period), as well as permanent disability based upon combined impairment from both injuries.

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.

PTPRelied upon · orthopedic surgeon

Provided substantial medical evidence supporting permanent disability for multiple orthopedic injuries based on reasonable medical probability and adequate examination.

The WCJ relied on Dr. Hannani's February 3, 2022 report as substantial medical evidence for injury and impairment.

From the decision · page 8Defendant also contends that Dr. Hannani's reports are lacking in substantial medical evidence "[w]ith respect to the [WCJ's] finding of permanent disability for [applicant's] multiple orthopedic injuries[.]" (Petition, p. 9.) Defendant refers to Dr. Hannani's February 3, 2022 report and alleges that Dr. Hannani failed to provide apportionment despite applicant's alleged prior history of injuries. (Petition, p. 9.) Notwithstanding the fact that apportionment findings between physicians will oftentimes vary, based upon our review of Dr. Hannani's report, we conclude that that his conclusions were based upon reasonable medical probability, pertinent facts, an adequate examination, and history. As such, we conclude that Dr. Hannani's February 3, 2022 report constitutes substantial medical evidence.

PTPRelied upon · neurosurgeon

Reports were challenged but found to be substantial medical evidence despite lack of record review, providing support for injury AOE/COE and impairment for migraines.

The Appeals Board rejected defendant's challenge to Dr. Edelman's reports and found them substantial evidence.

From the decision · page 7Here, defendant alleges that the reports of Dr. Edelman are not substantial medical evidence on the issues of injury AOE/COE and impairment for applicant's migraines because Dr. Edelman "did not review any records of the applicant." (Petition, pp. 6-7.) As proof, defendant points to a September 28, 2021 report wherein Dr. Edelman provided only a "provisional" diagnosis for applicant's migraines. (Id. at p. 7.) Defendant also references an August 11, 2020 report of Dr. Zlotolow as evidence of inconsistencies between applicant's medical history and the doctors' finding of injury AOE/COE for applicant's migraines. (Ibid.) The above reports, however, have not been admitted into the evidentiary record. As such, we will not consider any references to these reports. Pursuant to WCAB Rule 10620, "[a]ny document that a party proposes to offer into evidence at a trial shall be filed with the Workers' Compensation Appeals Board at least 20 days prior to the trial unless otherwise ordered by the Workers' Compensation Appeals Board." (Cal. Code Regs., tit. 8, § 10620.) WCAB Rule 10670(b) further provides, in relevant part, that the Appeals Board "may decline to receive in evidence... [a]ny document not filed 20 days prior to trial, unless otherwise ordered by a workers' compensation judge or good cause is shown." (Cal. Code Regs., tit. 8, § 10670(b)(3).) No good cause has been shown here.

PTPRelied upon · internist

Provided substantial medical evidence of injury AOE/COE and impairment for fibromyalgia, based on patient's history, ADLs, and agreement with Dr. Fisher's report.

The Appeals Board found Dr. Zlotolow's March 3, 2020 report to be substantial medical evidence supporting injury and impairment.

From the decision · page 7Defendant similarly argues that the reports of Dr. Zlotolow are lacking in substantial medical evidence. (Petition, pp. 7-8.) Defendant alleges that Dr. Zlotolow's March 3, 2020 report does not "explain causation" or "what section within the four corners of the AMA Guides" were used to establish injury AOE/COE and impairment for applicant's fibromyalgia. (Petition, p. 8.) In his report, however, Dr. Zlotolow clearly explains that his impairment findings are based upon

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Applicant prevailed

Reports of Drs. Hannani, Edelman, and Zlotolow were found to be substantial medical evidence supporting injury and impairment.

From the decision · page 8applicant's "problems with her ADLs" as well as "sleep issues" and an ongoing need for "prescribed medication." (Exhibit 11, p. 4.) He also notes that his conclusions were reached only after review of "the patient's history and diagnostic studies, as well as the report of Dr. Fisher." (Id. at p. 4.) In reference to Dr. Fisher's December 10, 2019 report, Dr. Zlotolow underscores his "complete agreement" that applicant's fibromyalgia is due to her "injuries on the job." (Ibid.) In his own report, Dr. Fisher refers to an article by D. Goldenberg entitled "Pathogenesis of Fibromyalgia" wherein Goldberg found that no "single event causes fibromyalgia. Rather, fibromyalgia is caused by "many physical and/or emotional stressors [that] may trigger or aggravate symptoms." (Exhibit 17, pp. 107-108.) Based upon the foregoing, we therefore conclude that Dr. Zlotolow's March 3, 2020 report constitutes substantial medical evidence of injury AOE/COE and impairment for applicant's fibromyalgia, attributable to both dates of injury.

Medical recordsfavours Applicant prevailed

Applicant was determined to be temporarily totally disabled during the period from July 20, 2019 through September 2, 2020, supporting retroactive temporary disability award.

From the decision · page 9Based upon our review of the January 21, 2025 FO&A and the September 22, 2020 FA&O, we see no conflicts. As demonstrated above, applicant has been seen by numerous treaters and QMEs for various ailments related to her injuries. This has given rise to a great many reports, sometimes with differing opinions, and corresponding changes to applicant's ability to return to work, permanent and stationary date, and benefits due. As such, although it is true that at the time of the September 22, 2020 FA&O, applicant had been made "a bona fide offer of modified work" and was therefore "not entitled to temporary partial or total disability from 6/22/2020 through 8/11/2020," it is also true applicant was later determined to be temporarily totally disabled and not permanent and stationary or able to work in any capacity during the period from July 20, 2019 through September 2, 2020.

ADJ11645837 · May 12, 2025

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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