ADJ15780886 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted in part to amend credit for earned income during the disputed period; otherwise, the August 14, 2024 Findings of Fact and Award affirmed.

Petition for Reconsideration filed by defendant Priority Business Services, Inc., dba Priority Workforce, was granted in part and denied in part by the WCAB panel, which adopted and incorporated the WCJ's report and amended the Findings of Fact and Award dated August 14, 2024.

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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.

Temporary disabilityApplicant prevailedlow back

The WCJ and WCAB found substantial medical evidence from PQME Dr. Lee Silver supporting that applicant was temporarily totally disabled from December 16, 2023 through June 26, 2024 and continuing, with credit for earned income from January 2024 onward, and no proper offer of modified work was served on applicant.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

PQME Dr. Lee Silver's medical opinion that applicant is not yet at MMI and is temporarily totally disabled in the absence of a proper offer of modified work.

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.

QMERelied upon · orthopedics

Applicant is not yet at Maximum Medical Improvement (MMI) or Permanent and Stationary (P&S) status and is temporarily totally disabled in the absence of a proper offer of modified work.

Dr. Silver's opinion was found substantial medical evidence supporting temporary disability and not yet MMI status, contrary to PTP Dr. Elias's MMI finding.

From the decision · page 7This court finds PQME Dr. Silver to be substantial medical evidence over PTP Dr. Elias. Based on applicant's credible testimony and the existing medical record, it is clear applicant's condition is not well stabilized. The earliest medical report provided as evidence by the parties is dated February 2, 2023, by Panel Qualified Medical Examiner (PQME) Dr. Lee Silver (Exhibit 5). In that supplemental report PQME Dr. Silver reviews correspondence and an MRI study of the lumbar spine of July 19, 2022. In his discussion he states that Applicant is not yet Permanent and Stationary (P&S) or at a Maximum Medical Improvement (MMI) (Exhibit 5 p. 2). On June 15, 2023, PQME Dr. Silver issued a supplemental report reviewing a variety of records. In his Discussion section Dr. Silver noted that the EMG and nerve conduction studies are normal. However, he observed that applicant has complaints of lumbosacral radiculopathy and positive MRI findings at the L4-L5 and L5-S1 levels including stenosis. Applicant was not MMI or P&S (Exhibit 4 p.2).

PTPRejected · orthopedics

Found applicant to be at MMI and Permanent and Stationary status as of August 3, 2023, based on exhaustion of conservative treatment and applicant's refusal of surgery, but did not adequately explain stabilization of condition.

Dr. Elias's MMI finding was rejected because it was based solely on treatment exhaustion and refusal of surgery, without evidence of medical stabilization.

From the decision · page 7On August 3, 2023, Primary Treating Physician (PTP) Dr. Ramy Elias saw applicant for P&S evaluation. In said report Dr. Elias notes that applicant has exhausted conservative treatment and is not interested in surgical treatment and thus will be discharged with permanent restrictions. Dr. Elias's diagnosis of applicant was that of a L4-5-disc herniation with right leg radiculopathy (Exhibit X3). Dr. Elias does not state that applicant is well stabilized, nor does he explain the reason for finding applicant MMI other than applicant exhausting all conservative treatment and not wanting surgery. In review of the subsequent reporting, it is evident that applicant's condition is not well stabilized since he is, in fact, getting worse with diagnosis of acute left lumbar radiculopathy just 3 months after Dr. Elias's MMI report (Exhibit X2 p. 4).

ADJ15780886 · November 18, 2024

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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