ADJ16035139 · September 21, 2026

The substantial medical evidence from PQME Dr. Simon, who opined with reasonable medical probability that the decedent's physical labor activities contributed to his cardiac arrest and death, was unrebutted and supported the finding of injury AOE/COE. Defendant's argument for medical certainty was rejected as the law requires only reasonable medical probability for causation.

From the decision · page 1Defendant seeks reconsideration of the Rulings and Orders Admitting Evidence, Findings of Fact and Order (FF&O) issued by the presiding workers’ compensation administrative law judge (PWCJ) on April 30, 2026, wherein it was found that decedent sustained an injury arising out of and in the course of his employment (AOE/COE) in the form of cardiac arrest resulting in his death on March 31, 2022, while employed by defendant as farm worker. Defendant contends that the finding of AOE/COE was not based on substantial medical evidence. 10F

Decedent suffered cardiac arrest shortly after beginning physical labor work as a farm laborer.

Favours Applicant prevailed

This fact established the temporal and causal connection between employment activities and the injury, supporting industrial causation.

From the decision · page 7In his December 2, 2024 report, Dr. Simon states that: “[a]pproximately 915 pages of records have been received and reviewed.” (Exhibit 7, Benjamin Simon, M.D., December 2, 2024, p. 1.) Under causation the doctor states: The applicant suffered a cardiac arrest shortly after beginning work. The applicant was employed as a farm laborer. A coworker documented that at the time of his collapse, he was performing physical activities consistent with his job duties as a farm laborer including removing leaves and debris from the shrubs of the grapevines with their hands.

PQME Dr. Simon's unrebutted medical opinion that the decedent's work activities were a contributing cause of death.

Favours Applicant prevailed

The Appeals Board relied on this substantial medical evidence to find injury AOE/COE despite defendant's objections.

From the decision · page 10(Id. at p. 23, lns 9-17, emphasis added.) In the Petition, defendant seeks to focus on the decedent’s limited work activities on the day of death and in doing so invites the trier of fact to arrive at a contrary medical conclusion. That is not the correct application of law in a workers’ compensation case. The trier of fact, as a lay person, is charged to determine the facts. Here there is no dispute as to the facts, but only a medical question as to whether those facts result in an industrial injury. In all but the simplest cases the question of industrial causal connection requires expert medical opinion. (McLaughlin, supra, at p. 839.) “Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board’s findings if it is based on surmise, speculation, conjecture or guess.” (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].) Although defendant takes great umbrage with PQME Dr. Simon’s opinions, defendant does not identify errors in the reporting other than an ultimate difference of opinion on causation. Defendant does not raise any issues with PQME Dr.

Opined with reasonable medical probability that the decedent's physical labor activities contributed to his cardiac arrest and subsequent death, constituting industrial causation.

His opinion was unrebutted and found to be substantial medical evidence supporting injury AOE/COE.

From the decision · page 7In his December 2, 2024 report, Dr. Simon states that: “[a]pproximately 915 pages of records have been received and reviewed.” (Exhibit 7, Benjamin Simon, M.D., December 2, 2024, p. 1.) Under causation the doctor states: The applicant suffered a cardiac arrest shortly after beginning work. The applicant was employed as a farm laborer. A coworker documented that at the time of his collapse, he was performing physical activities consistent with his job duties as a farm laborer including removing leaves and debris from the shrubs of the grapevines with their hands.

McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417

Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for finding injury AOE/COE.

The Appeals Board applied this standard to reject defendant's argument requiring medical certainty and to uphold the finding of injury AOE/COE based on reasonable medical probability.

From the decision · page 8The applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, §§ 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for finding injury AOE/COE. (McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408,

Credibility of PQME Dr. Simon's medical opinion was favored as substantial evidence supporting industrial causation despite defendant's objections.

From the decision · page 10(Id. at p. 23, lns 9-17, emphasis added.) In the Petition, defendant seeks to focus on the decedent’s limited work activities on the day of death and in doing so invites the trier of fact to arrive at a contrary medical conclusion. That is not the correct application of law in a workers’ compensation case. The trier of fact, as a lay person, is charged to determine the facts. Here there is no dispute as to the facts, but only a medical question as to whether those facts result in an industrial injury. In all but the simplest cases the question of industrial causal connection requires expert medical opinion. (McLaughlin, supra, at p. 839.) “Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board’s findings if it is based on surmise, speculation, conjecture or guess.” (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].) Although defendant takes great umbrage with PQME Dr. Simon’s opinions, defendant does not identify errors in the reporting other than an ultimate difference of opinion on causation. Defendant does not raise any issues with PQME Dr.