What the panel ordered
Petition for Reconsideration denied; applicant's claim for industrial injury not proven; applicant ordered to take nothing.
Petition for Reconsideration filed by applicant was considered and denied by the Appeals Board panel, adopting and incorporating the WCJ's Report and Opinion on 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.
Applicant did not meet burden of proof for industrial injury due to lack of substantial medical evidence and credibility concerns; QME Dr. Banks found medical evidence insufficient to substantiate injury claim; no witness testimony corroborated applicant's injury report.
From the decision · page 6I have carefully reviewed and considered the evidence submitted to me, including the medical records in evidence, as well as applicant's testimony at trial. In view of the overall record, I find that applicant has not met his burden of proof with regard to injury AOE/COE. See Mendoza v. Huntington Hospital (2010) 75 Cal. Comp. Cases 634, 644 ["it is the employee's burden to prove industrial causation, not the defendant's burden to disprove causation..]. I have reached this conclusion due to the lack of medical support of applicant's claim as well as due to the questionable factual basis for the claim. The only medical reports in evidence are the three reports of the QME, Dr. Banks, joint exhibits 1 through 3. In his final report, joint exhibit 3, Dr.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Banks found medical evidence insufficient to substantiate injury claim due to inconsistencies and delayed symptom reporting.
Favours Defendant prevailed
This undermined applicant's burden of proof for industrial injury, leading to denial of claim.
From the decision · page 6I have carefully reviewed and considered the evidence submitted to me, including the medical records in evidence, as well as applicant's testimony at trial. In view of the overall record, I find that applicant has not met his burden of proof with regard to injury AOE/COE. See Mendoza v. Huntington Hospital (2010) 75 Cal. Comp. Cases 634, 644 ["it is the employee's burden to prove industrial causation, not the defendant's burden to disprove causation..]. I have reached this conclusion due to the lack of medical support of applicant's claim as well as due to the questionable factual basis for the claim. The only medical reports in evidence are the three reports of the QME, Dr. Banks, joint exhibits 1 through 3. In his final report, joint exhibit 3, Dr.
Applicant's testimony credibility was questioned by WCJ based on demeanor and inconsistencies.
Favours Defendant prevailed
Credibility concerns contributed to denial of claim for lack of reliable evidence.
From the decision · page 6I have carefully reviewed and considered the evidence submitted to me, including the medical records in evidence, as well as applicant's testimony at trial. In view of the overall record, I find that applicant has not met his burden of proof with regard to injury AOE/COE. See Mendoza v. Huntington Hospital (2010) 75 Cal. Comp. Cases 634, 644 ["it is the employee's burden to prove industrial causation, not the defendant's burden to disprove causation..]. I have reached this conclusion due to the lack of medical support of applicant's claim as well as due to the questionable factual basis for the claim. The only medical reports in evidence are the three reports of the QME, Dr. Banks, joint exhibits 1 through 3. In his final report, joint exhibit 3, Dr.
No witness testimony corroborated applicant's report of injury to supervisors on date of incident.
Favours Defendant prevailed
Lack of corroboration weakened applicant's claim and supported denial.
From the decision · page 17Given these inconsistencies, and the absence of medical evidence related to the claimed injury of June 16, 2020, with the first mention of symptoms being in March 2021, concern is raised for subsequent employment being responsible for components of the injury (and may be the injury itself). As such I do believe industrial causation should be determined by the trier of fact as the medical evidence produced is insufficient in substantiating the claim of injury as noted by the applicant. Of note, the applicant did state his claimed injury of June 16, 2020, was witnessed and he promptly reported it to his supervisors who did not offer him medical attention. To date I have not received any witness testimonies to corroborate this history. (Id., at p. 5, emphasis added.)
Medical records show first mention of symptoms related to claimed injury months after alleged incident, raising concern for subsequent employment as cause.
Favours Defendant prevailed
Delayed symptom reporting undermined claim of industrial injury causation.
From the decision · page 17Given these inconsistencies, and the absence of medical evidence related to the claimed injury of June 16, 2020, with the first mention of symptoms being in March 2021, concern is raised for subsequent employment being responsible for components of the injury (and may be the injury itself). As such I do believe industrial causation should be determined by the trier of fact as the medical evidence produced is insufficient in substantiating the claim of injury as noted by the applicant. Of note, the applicant did state his claimed injury of June 16, 2020, was witnessed and he promptly reported it to his supervisors who did not offer him medical attention. To date I have not received any witness testimonies to corroborate this history. (Id., at p. 5, emphasis added.)
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.
Medical evidence insufficient to substantiate claim of injury; inconsistencies in injury reporting; first symptoms mentioned months after alleged injury; recommended causation determination by trier of fact.
Dr. Banks noted inconsistencies in injury reporting and absence of medical evidence related to claimed injury; medical evidence insufficient to substantiate claim.
From the decision · page 6I have carefully reviewed and considered the evidence submitted to me, including the medical records in evidence, as well as applicant's testimony at trial. In view of the overall record, I find that applicant has not met his burden of proof with regard to injury AOE/COE. See Mendoza v. Huntington Hospital (2010) 75 Cal. Comp. Cases 634, 644 ["it is the employee's burden to prove industrial causation, not the defendant's burden to disprove causation..]. I have reached this conclusion due to the lack of medical support of applicant's claim as well as due to the questionable factual basis for the claim. The only medical reports in evidence are the three reports of the QME, Dr. Banks, joint exhibits 1 through 3. In his final report, joint exhibit 3, Dr.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5705; South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291
Employee bears initial burden of proving injury arising out of and in the course of employment by preponderance of evidence.
Applicant did not meet burden of proof for industrial injury due to lack of substantial medical evidence and credibility concerns.
From the decision · page 1The employee bears the initial burden of proving injury arising out of and in the course of employment (AOE/COE) by a preponderance of the evidence. (Lab. Code, § 5705; South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3202.5, 3600(a).) Moreover, it is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310];
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony credibility concerns due to demeanor observed by WCJ.
From the decision · page 6I have carefully reviewed and considered the evidence submitted to me, including the medical records in evidence, as well as applicant's testimony at trial. In view of the overall record, I find that applicant has not met his burden of proof with regard to injury AOE/COE. See Mendoza v. Huntington Hospital (2010) 75 Cal. Comp. Cases 634, 644 ["it is the employee's burden to prove industrial causation, not the defendant's burden to disprove causation..]. I have reached this conclusion due to the lack of medical support of applicant's claim as well as due to the questionable factual basis for the claim. The only medical reports in evidence are the three reports of the QME, Dr. Banks, joint exhibits 1 through 3. In his final report, joint exhibit 3, Dr.
Absence of witness testimony corroborating applicant's injury report.
From the decision · page 17Given these inconsistencies, and the absence of medical evidence related to the claimed injury of June 16, 2020, with the first mention of symptoms being in March 2021, concern is raised for subsequent employment being responsible for components of the injury (and may be the injury itself). As such I do believe industrial causation should be determined by the trier of fact as the medical evidence produced is insufficient in substantiating the claim of injury as noted by the applicant. Of note, the applicant did state his claimed injury of June 16, 2020, was witnessed and he promptly reported it to his supervisors who did not offer him medical attention. To date I have not received any witness testimonies to corroborate this history. (Id., at p. 5, emphasis added.)
Medical evidence shows first mention of symptoms months after alleged injury, raising concern for subsequent employment as cause.
From the decision · page 17Given these inconsistencies, and the absence of medical evidence related to the claimed injury of June 16, 2020, with the first mention of symptoms being in March 2021, concern is raised for subsequent employment being responsible for components of the injury (and may be the injury itself). As such I do believe industrial causation should be determined by the trier of fact as the medical evidence produced is insufficient in substantiating the claim of injury as noted by the applicant. Of note, the applicant did state his claimed injury of June 16, 2020, was witnessed and he promptly reported it to his supervisors who did not offer him medical attention. To date I have not received any witness testimonies to corroborate this history. (Id., at p. 5, emphasis added.)
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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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