What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration of WCJ Findings of Fact issued February 18, 2021, denied by WCAB panel 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.
The WCAB found no substantial medical evidence to support an award of temporary disability benefits from November 2, 2020, onward, as the medical reports did not meet the substantial evidence criteria and the applicant was already receiving lifetime medical treatment after the injury was deemed permanent and stationary.
From the decision · page 1Applicant seeks reconsideration of the Findings of Fact, (Findings) issued by the workers' compensation administrative law judge (WCJ) on February 18, 2021, wherein the WCJ found in pertinent part that applicant sustained injury arising out of and occurring in the course of employment (AOE/COE) to her left shoulder, and that applicant was not entitled to temporary disability benefits for the period from November 2, 2020, "to present." (Findings.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's condition was deemed permanent and stationary on July 31, 2018
Favours Defendant prevailed
This fact indicated that the applicant's injury was no longer in a temporary phase, undermining the claim for temporary disability benefits.
From the decision · page 1Applicant claimed injury to her face, eye, left shoulder, and chest while employed by defendant as a teacher on September 29, 2017. Applicant's condition was deemed permanent and stationary (P&S) on July 31, 2018, by the treating physician Shelley Anais Arredondo, M.D. (Def. Exh. A, Dr. Arrendondo, July 31, 2018.) Dr. Arredondo stated that applicant's work restrictions, as a result of her injury were, "No lifting/pushing/pulling/carrying greater than 10 lbs." and she
Dr. Mealer's November 2, 2020 report did not meet substantial evidence criteria for temporary disability
Favours Defendant prevailed
The report lacked reasonable medical probability and reasoning, so it could not support an award of temporary disability benefits.
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.
Deemed applicant's condition permanent and stationary on July 31, 2018, with work restrictions including no lifting/pushing/pulling/carrying greater than 10 lbs and no return to regular duty; estimated need for further medical treatment for five years.
From the decision · page 1Applicant claimed injury to her face, eye, left shoulder, and chest while employed by defendant as a teacher on September 29, 2017. Applicant's condition was deemed permanent and stationary (P&S) on July 31, 2018, by the treating physician Shelley Anais Arredondo, M.D. (Def. Exh. A, Dr. Arrendondo, July 31, 2018.) Dr. Arredondo stated that applicant's work restrictions, as a result of her injury were, "No lifting/pushing/pulling/carrying greater than 10 lbs." and she
November 2, 2020 progress report stated applicant's disability status as 'disability' and current work status as 'off work' but did not comply with substantial evidence criteria for temporary disability as it was not framed in terms of reasonable medical probability and lacked reasoning.
Did not comply with substantial evidence criteria for temporary disability as it was not framed in terms of reasonable medical probability and lacked reasoning.
From the decision · page 2Subsequently, applicant received treatment from William Mealer, M.D. Dr. Mealer's November 2, 2020 progress report (PR-2) includes the following:
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, § 5952(d)
An award of benefits must be supported by substantial evidence
The WCAB applied this standard to require substantial evidence for temporary disability benefits.
From the decision · page 2DISCUSSION Any award, of benefits by the Appeals Board, including an award of temporary disability indemnity, must be supported by substantial evidence. (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].) We first note, the fact that an injured worker is receiving medical treatment is not in and of itself substantial evidence that the injured worker is temporarily totally disabled. It is quite common for an injured worker to be awarded lifetime medical treatment after the injury condition became permanent and stationary, as was done in this matter. (see e.g. DWC-WCAB form 10214(a) - Stipulations with Request for Award.) Applicant testified that she last worked on May 30, 2018. (MOH/SOE, p. 4.) Applicant's condition was deemed P&S on July 31, 2018. (Def. Exh.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
Medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and must set forth reasoning
The WCAB applied this standard to reject Dr. Mealer's reports as insufficient substantial evidence for temporary disability.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony that she last worked on May 30, 2018
From the decision · page 2DISABILITY STATUS: DISABILITY CURRENT WORK STATUS: OFF WORK Work Status: Remain off-work until (x) (App. Exh. 1, Dr. Mealer, November 2, 2020, pp. 1 and 2.) On December 3, 2020, applicant filed a Petition to Reopen for New and Further Disability. The parties proceeded to an Expedited Hearing on January 20, 2021. Applicant testified that her left shoulder pain has worsened since the time of the settlement and that she is receiving treatment from Dr. Mealer. (Minutes of Hearing and Summary of Evidence (MOH/SOE), December 3, 2020, pp. 3 § 4.) She also testified that, "The last time she earned income from a job was May 30, 2018." (MOH/SOE, p. 4.) The issues submitted for decision included temporary disability, with applicant claiming she was temporarily totally disabled for the period from November 2, 2020, to the date of the trial and ongoing. (MOH/SOE, p. 2.)
Applicant's condition deemed permanent and stationary on July 31, 2018
From the decision · page 1Applicant claimed injury to her face, eye, left shoulder, and chest while employed by defendant as a teacher on September 29, 2017. Applicant's condition was deemed permanent and stationary (P&S) on July 31, 2018, by the treating physician Shelley Anais Arredondo, M.D. (Def. Exh. A, Dr. Arrendondo, July 31, 2018.) Dr. Arredondo stated that applicant's work restrictions, as a result of her injury were, "No lifting/pushing/pulling/carrying greater than 10 lbs." and she
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About this page
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