What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed by Defendant from Findings of Fact, Award and Order dated 5/28/21, considered and denied by WCAB panel on 8/16/21
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 IME's apportionment opinion was found not to be substantial evidence because it lacked the necessary explanation and reasoning required by precedent cases, failing to meet the burden of proof for apportionment.
From the decision · page 3Applicant alleged an industrial injury to his right ankle, right knee, right hip and left knee. The IME, Dr. Gerard Dericks, first found an industrial injury arising from the specific injury of 1/22/19 to the right hip, knee and ankle, and that the left knee symptoms were a compensable consequence of this specific injury (page 13, Joint Exhibit C), but in his report of 10/27/20 (Joint Exhibit A), he modified that opinion on page 10 to conclude that, "...based on a reasonable degree of medical probability, that 50 percent of the bilateral knee, right hip and right ankle permanent disability is related to the 1.22.19 injury, and compensatory consequences of that injury, and 50 percent is related to the prior right ankle and left knee surgeries and pre-existing degeneration."
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
IME Dr. Dericks modified his opinion from 100% industrial injury to a 50/50 split between industrial injury and pre-existing conditions without sufficient explanation.
Favours Applicant prevailed
This lack of explanation and reasoning led to the rejection of the IME's apportionment opinion as not substantial evidence.
From the decision · page 5Looking forward, the doctor modified this opinion in his report of 10/27/20 (Joint Exhibit A, page 10) to state that based on a review of additional medical records, he now apportioned 50% of the disability to all four body parts to the specific industrial injury, and the remaining 50% to the prior right ankle and left knee surgeries, and pre-existing degeneration.
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.
Initially found 100% disability due to the 1/22/19 injury; later modified to 50% industrial injury and 50% pre-existing conditions without sufficient explanation or reasoning for apportionment percentages.
The opinion lacked the necessary explanation and reasoning to constitute substantial evidence for apportionment.
From the decision · page 3Applicant alleged an industrial injury to his right ankle, right knee, right hip and left knee. The IME, Dr. Gerard Dericks, first found an industrial injury arising from the specific injury of 1/22/19 to the right hip, knee and ankle, and that the left knee symptoms were a compensable consequence of this specific injury (page 13, Joint Exhibit C), but in his report of 10/27/20 (Joint Exhibit A), he modified that opinion on page 10 to conclude that, "...based on a reasonable degree of medical probability, that 50 percent of the bilateral knee, right hip and right ankle permanent disability is related to the 1.22.19 injury, and compensatory consequences of that injury, and 50 percent is related to the prior right ankle and left knee surgeries and pre-existing degeneration."
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Granado v. WCAB (1970) 69 Cal. 2d 399
An expert's opinion must set forth the reasoning behind the opinion, not merely conclusions, to be substantial evidence.
Applied to reject the IME's apportionment opinion for lack of reasoning.
From the decision · page 4The law is clear as to the determination of substantiality. An expert's opinion must set forth the reasoning behind the opinion, not merely his or her conclusions. Granado v. WCAB (1970) 69 Cal. 2d 399, 407.
People v. Bassett (1968) 69 Cal. 2d 122
The chief value of expert testimony rests on the material and reasoning behind the opinion.
Applied to emphasize the need for reasoning in expert opinions on apportionment.
From the decision · page 4In People v. Bassett (1968) 69 Cal. 2d 122, 141,144, it is stated that the chief value of an expert's testimony rests on the material from which his or her opinion is fashioned and the reasoning by which he or she progresses from the material to the conclusion.
Escobedo v. Marshalls (2005) 70 CCC 604 (en banc)
Physician must explain how and why disability is causally related to industrial injury and non-industrial causes for apportionment.
Applied to require detailed explanation for apportionment percentages in the IME's opinion.
From the decision · page 4More specifically, in Escobedo v. Marshalls (2005) 70 CCC 604 (en banc), this requirement is discussed in detail as it is relevant to the question of apportionment. In order to make the requirements clear, the board, sitting en banc, gave an example as follows:
What proof carried it
The evidence the panel weighed, by kind.
IME's opinion lacked sufficient explanation and reasoning for apportionment percentages
From the decision · page 4This is the missing part in this case, and it is by definition the most important part.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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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