What the panel ordered
The Petition for Reconsideration was granted, the Findings, Award & Orders of April 24, 2026 were rescinded, and the matter was returned to the WCJ for further proceedings.p. 15
Defendant sought reconsideration of the WCJ's Findings, Award, and Orders issued on April 24, 2026. The WCAB granted reconsideration, rescinded the WCJ's decision, and returned the matter to the WCJ for further proceedings consistent with the decision.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 WCJ's impairment rating based on the QME's Almaraz/Guzman analysis was found not supported by substantial medical evidence, and the matter was remanded for further proceedings.
From the decision · page 1Defendant seeks reconsideration of the Joint Findings, Award, and Orders (F&A) issued on April 24, 2026. The workers’ compensation administrative law judge (WCJ) found, in relevant part, that in ADJ14149688 applicant sustained injury to his cervical spine and lumbar spine and applicant did not meet his burden of proof that he sustained injury arising out of and in the course of employment to the excretory system, bilateral upper extremities and bilateral lower extremities; in ADJ21878559 applicant did not meet his burden of proof that he sustained injury to the excretory system, spine, neck, bilateral upper extremities, and bilateral lower extremities during the period of February 3, 2020 through December 2, 2025; that applicant
The QME's opinion cutting off medical care after March 6, 2021 was found to be an impermissible apportionment and not supported by substantial evidence, leading to remand for further development.
From the decision · page 12Chen’s opinion that all treatment rendered after the March 6, 2021 surveillance is nonindustrial, and that there is no need for future medical care for the neck and back. We emphasize the point made by the WCJ that this opinion amounts to impermissible apportionment of medical treatment. If the need for medical treatment is partially caused by an applicant’s industrial injury, an employer must pay all the injured worker’s reasonable medical expenses. (Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399, [33 Cal.Comp.Cases 647].) An injured worker is entitled to medical care for a non-industrial condition that must be treated in order to cure or relieve the effects of an industrial injury. (Bolton, supra, 34 Cal.3d 159.) Dr. Chen does not indicate any medical basis for cutting off industrial liability for medical treatment that he opined was warranted up to the point of the March 2021 surveillance. Likewise, his opinion still states that the injuries are 100% industrial. He is consistent that the industrial motor vehicle accident caused injury to the cervical and lumbar spines. There is no evidence anywhere in the record of an intervening event that would sever causation for ongoing care. Moreover, the spine is listed in diagnoses from the beginning of the medical record. Again, the opinion is not supported, is contradictory, and is not substantial.
The WCJ found defendant did not meet burden of proof for credit for overpayment for the period March 6, 2021 through February 8, 2022.
The WCJ's original permanent and stationary date was challenged but ultimately the matter was remanded for further proceedings.
From the decision · page 1Defendant seeks reconsideration of the Joint Findings, Award, and Orders (F&A) issued on April 24, 2026. The workers’ compensation administrative law judge (WCJ) found, in relevant part, that in ADJ14149688 applicant sustained injury to his cervical spine and lumbar spine and applicant did not meet his burden of proof that he sustained injury arising out of and in the course of employment to the excretory system, bilateral upper extremities and bilateral lower extremities; in ADJ21878559 applicant did not meet his burden of proof that he sustained injury to the excretory system, spine, neck, bilateral upper extremities, and bilateral lower extremities during the period of February 3, 2020 through December 2, 2025; that applicant
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The QME's revised impairment ratings to zero percent whole person based on surveillance video were conclusory and lacked detailed explanation.
Favours Applicant prevailed
This led to rejection of the QME's impairment rating and remand for further proceedings.
From the decision · page 11Here, the QME, in support of rebutting the strict AMA ratings for the cervical and lumbar spines, simply stated: I would therefore utilize the latitude afforded by the Almarez II decisions and revise his cervical spine and lumbar spine impairment ratings to zero percent whole person based on the range of motion and comfort as visualized in the video surveillance footage. I would also amend the pain add-on impairment to zero percent whole person impairment.
The QME's opinion cutting off medical care after March 6, 2021 was contradictory and unsupported by medical basis.
Favours Applicant prevailed
This led to rejection of the opinion and remand for further development of the medical record.
From the decision · page 12Chen’s opinion that all treatment rendered after the March 6, 2021 surveillance is nonindustrial, and that there is no need for future medical care for the neck and back. We emphasize the point made by the WCJ that this opinion amounts to impermissible apportionment of medical treatment. If the need for medical treatment is partially caused by an applicant’s industrial injury, an employer must pay all the injured worker’s reasonable medical expenses. (Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399, [33 Cal.Comp.Cases 647].) An injured worker is entitled to medical care for a non-industrial condition that must be treated in order to cure or relieve the effects of an industrial injury. (Bolton, supra, 34 Cal.3d 159.) Dr. Chen does not indicate any medical basis for cutting off industrial liability for medical treatment that he opined was warranted up to the point of the March 2021 surveillance. Likewise, his opinion still states that the injuries are 100% industrial. He is consistent that the industrial motor vehicle accident caused injury to the cervical and lumbar spines. There is no evidence anywhere in the record of an intervening event that would sever causation for ongoing care. Moreover, the spine is listed in diagnoses from the beginning of the medical record. Again, the opinion is not supported, is contradictory, and is not substantial.
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.
Dr. Chen diagnosed cervical strain with radiculopathy, right sternoclavicular joint subluxation, lumbar strain with radiculopathy, and right shoulder rotator cuff tear post-surgery. He found all injuries industrially caused and initially did not find applicant to be MMI. Later, he revised cervical and lumbar spine impairment ratings to zero percent whole person based on surveillance video, but this opinion was found conclusory and not substantial medical evidence.
Dr. Chen's revised impairment ratings based on surveillance video did not comply with Almaraz/Guzman requirements and lacked detailed explanation correlating objective findings with impairment ratings.
From the decision · page 11Here, the QME, in support of rebutting the strict AMA ratings for the cervical and lumbar spines, simply stated: I would therefore utilize the latitude afforded by the Almarez II decisions and revise his cervical spine and lumbar spine impairment ratings to zero percent whole person based on the range of motion and comfort as visualized in the video surveillance footage. I would also amend the pain add-on impairment to zero percent whole person impairment.
Dr. Chen opined that medical treatment after March 6, 2021 surveillance was non-industrial and not needed, but this was found to be an impermissible apportionment of medical treatment and not supported by substantial evidence.
Dr. Chen's opinion cutting off medical care after March 6, 2021 was contradictory and unsupported by medical basis, conflicting with the principle that medical care for non-industrial conditions related to industrial injury must be provided.
From the decision · page 12Chen’s opinion that all treatment rendered after the March 6, 2021 surveillance is nonindustrial, and that there is no need for future medical care for the neck and back. We emphasize the point made by the WCJ that this opinion amounts to impermissible apportionment of medical treatment. If the need for medical treatment is partially caused by an applicant’s industrial injury, an employer must pay all the injured worker’s reasonable medical expenses. (Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399, [33 Cal.Comp.Cases 647].) An injured worker is entitled to medical care for a non-industrial condition that must be treated in order to cure or relieve the effects of an industrial injury. (Bolton, supra, 34 Cal.3d 159.) Dr. Chen does not indicate any medical basis for cutting off industrial liability for medical treatment that he opined was warranted up to the point of the March 2021 surveillance. Likewise, his opinion still states that the injuries are 100% industrial. He is consistent that the industrial motor vehicle accident caused injury to the cervical and lumbar spines. There is no evidence anywhere in the record of an intervening event that would sever causation for ongoing care. Moreover, the spine is listed in diagnoses from the beginning of the medical record. Again, the opinion is not supported, is contradictory, and is not substantial.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code §§ 5903, 5952(d)
Substantial evidence must support decisions by the Appeals Board.
The WCJ's impairment rating was found not supported by substantial medical evidence and was remanded for further proceedings.
From the decision · page 9Section 5909(b)(2) provides that service of the Report and Recommendation shall be notice of transmission. Here, according to the proof of service for the Report and Recommendation by the workers’ compensation administrative law judge, the Report was served on May 27, 2026 and the case was transmitted to the Appeals Board on May 27, 2026. Service of the Report and transmission of the case to the Appeals Board occurred on the same day. Thus, we conclude that the parties were provided with the notice of transmission required by section 5909(b)(1) because service of the Report in compliance with section 5909(b)(2) provided them with actual notice as to the commencement of the 60-day period on May 27, 2026. II. 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]; LeVesque v. Workmen’s Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal. Comp. Cases 16].) “The term ‘substantial evidence’ means evidence which, if true, has
Almaraz/Guzman analysis for rebutting scheduled permanent disability ratings under AMA Guides.
The QME's impairment rating did not meet the specific parameters required by Almaraz/Guzman and was rejected.
From the decision · page 10en banc) (commonly known as, and hereinafter referred to as Almaraz II), we held that a “scheduled permanent disability rating may be rebutted by successfully challenging the component element of that rating relating to the employee’s WPI under the AMA Guides….by establishing that another chapter, table, or method within the four corners of the Guides most accurately reflects the injured employee’s impairment.” (Almaraz II, 74 Cal.Comp.Cases at pp. 1095-1096.) In Milpitas Unified School District v. Workers’ Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837], the Court affirmed our decision in Almaraz II. In order for an applicant to prevail on this whole person impairment (WPI) assigned under Almaraz II, additional evidence is necessary: The doctor is expected to 1) provide a strict rating per the AMA Guides, 2) explain why the strict rating does not accurately reflect the applicant’s disability, 3) provide an alternative rating using the four corners of the AMA Guides, and 4) explain why that alternative rating most accurately reflects applicant’s level of disability. (Id. at pp. 828-829.)
Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399; Bolton v. Workers’ Comp. Appeals Bd. (1983) 34 Cal.3d 159
An employer must pay all reasonable medical expenses for treatment partially caused by industrial injury; medical care for non-industrial conditions related to industrial injury must also be provided.
The QME's opinion cutting off medical care after March 6, 2021 was found to be an impermissible apportionment and not supported by substantial evidence.
From the decision · page 12Chen’s opinion that all treatment rendered after the March 6, 2021 surveillance is nonindustrial, and that there is no need for future medical care for the neck and back. We emphasize the point made by the WCJ that this opinion amounts to impermissible apportionment of medical treatment. If the need for medical treatment is partially caused by an applicant’s industrial injury, an employer must pay all the injured worker’s reasonable medical expenses. (Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399, [33 Cal.Comp.Cases 647].) An injured worker is entitled to medical care for a non-industrial condition that must be treated in order to cure or relieve the effects of an industrial injury. (Bolton, supra, 34 Cal.3d 159.) Dr. Chen does not indicate any medical basis for cutting off industrial liability for medical treatment that he opined was warranted up to the point of the March 2021 surveillance. Likewise, his opinion still states that the injuries are 100% industrial. He is consistent that the industrial motor vehicle accident caused injury to the cervical and lumbar spines. There is no evidence anywhere in the record of an intervening event that would sever causation for ongoing care. Moreover, the spine is listed in diagnoses from the beginning of the medical record. Again, the opinion is not supported, is contradictory, and is not substantial.
What proof carried it
The evidence the panel weighed, by kind.
Surveillance videos from March 6, 2021 and May 2-3, 2023 showing applicant's activities inconsistent with reported pain and impairment.
From the decision · page 6cervical spine and lumbar spine, adding that any treatment after the March 6, 2021 surveillance would be non-industrial. In regard to the change of opinion on impairment and treatment he stated: These videos change my opinion regarding the applicant's level of impairment because I consider them substantial medical evidence that the applicant's level of function is much higher than he reported. The surveillance videos show a high level of function that is not consistent with his presentations to his health care providers. The video surveillance of March 6, 2021 shows the applicant comfortably smoking outside of his home, getting in and out of a car, standing in line at an ATM machine, walking and rubbing his hands. I reviewed the video surveillance on May 2, 2023 of the applicant getting into and out of a car, entering and exiting a home all appearing very comfortable and in no distress.
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