What the panel treated as outcome-determinative, and which side it favoured.
QME Sayed Miry found applicant permanent and stationary as of June 27, 2025, with a 20% whole person impairment rating for lumbar spine.
Favours Applicant prevailed
This established the date after which temporary disability payments were not due, relevant to the credit for overpayment issue.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not
entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25,
2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on
June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint
Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report,
through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the
claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky,
which may have possibly further delayed action by defendant. The applicant continued to receive
temporary disability payments after the re-evaluation with the QME and had no reason to believe
he was not entitled to them.
The QME's apportionment opinion lacked substantial evidence as it failed to explain how and why the nonindustrial conditions caused 20% of the disability and apportioned causation of the injury rather than the disability.
Favours Applicant prevailed
This led to the finding that defendant did not meet its burden of proof for non-industrial apportionment under Labor Code section 4663.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial
evidence as that term has come to be defined within the context of Labor Code section 4663. My
conclusion here is driven by the lack of analysis on the part of the QME to explain how and why
he believes the nonindustrial conditions are responsible for causing twenty percent of the current
disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr.
Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to
applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work
restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses
apportionment in relation to the injury itself, rather than the disability it caused.
Delay in service of the QME report until July 15, 2025, and service to an out-of-state address possibly caused further delay, which was not the applicant's fault.
Favours Applicant prevailed
This supported denial of credit for overpayment as the applicant received payments in good faith without wrongdoing.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not
entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25,
2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on
June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint
Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report,
through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the
claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky,
which may have possibly further delayed action by defendant. The applicant continued to receive
temporary disability payments after the re-evaluation with the QME and had no reason to believe
he was not entitled to them.