ADJ12129071 — California WCAB decision

What the panel ordered

Reconsideration granted, WCJ's decision rescinded, matter returned to WCJ for further proceedings and decision.

Petition for reconsideration of WCJ's July 20, 2022 decision denying compensability of applicant's psychiatric injury claim based on good faith personnel action defense; WCAB reviewed and incorporated WCJ's report.

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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.

Psyche AOE/COERemandedpsyche

The WCJ erroneously relied on the treating physician's causation analysis as if it were the PQME's, and the PQME's report was incomplete and not substantial evidence. The matter requires further factual findings and a supplemental PQME report to determine compensability under Rolda.

From the decision · page 7If the undersigned were to rely upon the treating physician's causation analysis, applicant's claim would be barred by GFPA. However, the parties agreed to utilize a PQME to address the issue of causation/compensability and his reporting is incomplete and not substantial. Both parties have an obligation to complete the reporting. If reconsideration is granted and the matter returned to the undersigned, findings of fact relating to applicant's claimed stressors (did they occur or not), and whether they were actual events of employment or not, and which, if any, were good faith personnel actions, would be made. Then the PQME can readdress his causation analysis in compliance with Rolda.

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.

QMERecord developed further · psychology

PQME noted applicant's treating physician attributed 60% of psychiatric injury to personnel meeting and 40% to job threat, but PQME did not concur or reject this analysis and stated his report was incomplete, leaving legal causation to the trier of fact.

PQME's report was not substantial evidence and did not resolve causation/compensability; further development required.

From the decision · page 6The parties also submitted panel qualified medical evaluator (PQME) reporting from Abraham Argun, Psy.D. (Court Exhibits 1-2). The PQME noted in his reporting that applicant had received no written reprimands, but "thought harsher punishment would come next", and she "thought that her supervisors were trying to push her out". His testing analysis included findings that applicant was hypersensitive and somewhat suspicious and untrusting of others, and that she was easily hurt by even mild criticism. He concluded that applicant sustained a psychiatric injury requiring some treatment but left the issue of compensability up to the trier of fact. Although he noted that applicant's treating physician had concluded that 60% of applicant's psychiatric injury was due to the personnel meeting on 8/16/18, and that 40% was due to her feeling that her job was threatened, the PQME did not state that he concurred with that assessment. In addition, although the PQME noted that applicant claimed harassment, hostility, and that her work restrictions from a prior injury were not being honored by the employer, the undersigned did not make specific findings on whether applicant's claims were factually valid. The PQME concluded that his reporting was incomplete and the "The legal aspect of causation is a matter of trier of fact (sic) (Court Exhibit 2, page 15).

PTPPartially credited · psychology

PTP attributed applicant's physical symptoms and emotional distress to the 8/16/18 personnel meeting and provided a causation analysis (60% due to meeting, 40% due to job threat).

PTP's causation analysis was referenced but not adopted by PQME; further factual findings required.

From the decision · page 6Shortly after the 8/16/18 personnel meeting, applicant contacted the employer's return to work department and made a formal stress related complaint. From the history/record summary contained in the submitted medicals, it appears that applicant sought evaluation and treatment on 8/21/18 at Kaiser complaining about stress "over the past week, feeling like she is being singled out and over-worked over the last week". She was taken off work for a week at that time (Court Exhibit 1, page 8). On 9/11/18, applicant was seen for the first time by Fariba Kezel, Ph.D., who chronicled that applicant "...attributes physical symptoms and emotional distress to a personnel meeting of 8/16/18, during which she reportedly received negative feedback - was counseled about her work performance by her two supervisors" The doctor noted that applicant denied further disciplinary actions were discussed by her supervisors during the meetings.

ADJ12129071 · October 12, 2022

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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