ADJ15278441 — California WCAB decision

ADJ15278441 · January 27, 2025

Petition for reconsideration granted; WCJ's decision amended to find injury AOE/COE to neck, upper extremities, hands, and arms; issue of lien claimant's entitlement to payment deferred; matter returned to WCJ for further proceedings.

Issues decided

Medical opinions weighed

Authorities named

District office

Van Nuys

What the panel ordered

Petition for reconsideration of WCJ's October 30, 2024 Findings, Award, and Order, which denied injury AOE/COE and reimbursement to Dr. Haghighinia. WCAB granted reconsideration, amended findings to establish injury AOE/COE, and deferred lien claimant's entitlement to payment.

Read the official 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.

AOE/COEApplicant prevailedneck · upper extremities · hands · arms

Dr. Haghighinia's reports provided substantial medical evidence of industrial causation based on accurate history, examination, and reasoned explanation linking work exposure to injury.

From the decision · page 6Based upon our review of Dr. Haghighinia's reports, including the medical legal report dated November 22, 2021, Dr. Haghighinia took an accurate and adequate history of the injury, thoroughly examined the applicant, and explained how and why the industrial work exposure caused applicant's complaints. As such, we find that Dr. Haghighinia's reporting constitutes substantial medical evidence of injury AOE/COE to the neck, wrist, hands, upper extremities, and arms.

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. WCAB (Clark); E.L. Yeager v. WCAB (Gatten)

Burden of proof rests on employee to establish industrial causation by preponderance of evidence; substantial evidence must be based on reasonable medical probability, accurate history, and reasoned explanation.

Applied to determine whether Dr. Haghighinia's report constituted substantial evidence of injury AOE/COE.

From the decision · page 5II. Turning now to the merits of the Petition, it is well-established that the burden of proof rests upon the party holding the affirmative of the issue. (Lab. Code, § 5705.) As such, when an employee claims injury AOE/COE, it is the employee who carries the burden of proof in establishing industrial causation and they must show that their employment was a contributing cause. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297- 298, 302; § 5705.) Once this burden has been met, the burden then shifts to the employer to provide evidence in rebuttal. Section 3600(a) provides further guidance as to the two-part requirement for establishing injury AOE/COE. Pursuant to section 3600(a)(2), "at the time of the injury," the employee must be "performing service growing out of and incidental to his or her employment" and be "acting within the course of his or her employment." (Lab. Code, § 3600(a)(2).) With respect to the first part, i.e.

Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588, 1592 (en banc)

Lien claimant must prove all elements necessary to establish its lien, including substantial evidence of injury AOE/COE.

Applied to determine lien claimant's burden in proving entitlement to payment for medical treatment services.

From the decision · page 61588, 1592 (Appeals Board en banc).) This includes establishing substantial evidence of injury AOE/COE. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) In order to constitute substantial evidence, an expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and examination, and must set forth reasoning to support the expert conclusions reached. (E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v.

ADJ15278441 · January 27, 2025

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page