What the panel ordered
Petition for Reconsideration granted; prior Findings of Fact and Orders rescinded; matter returned to WCJ for further proceedings
Petition for Reconsideration granted; prior Findings of Fact and Orders rescinded; matter returned to WCJ for further proceedings
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.
PQME Dr. Taylor's opinions on causation were found not to be substantial medical evidence due to lack of reasoning, incomplete record, and incorrect history; therefore, the matter was remanded for further proceedings.
From the decision · page 11evidence. PQME Dr. Taylor discusses many contributing factors he believes have a bearing on the cause of applicant's claimed injury to provide percentages of causation, but PQME Dr. Taylor does not provide the reasoning linking the factors to the injury. This defect is not cured by referring to clinical expertise and years of training. Further, PQME Dr. Taylor provided opinions based on an incomplete record and appears to have relied on an incorrect history. In summary, PQME Dr. Taylor's opinions are not substantial evidence. (Hegglin, supra, pp. 169-170.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. Taylor's opinions lacked explanation and were based on incomplete and inaccurate information
Favours Applicant prevailed
This undermined the substantiality of the medical evidence supporting causation, leading to the decision to grant reconsideration and remand for further proceedings.
From the decision · page 11evidence. PQME Dr. Taylor discusses many contributing factors he believes have a bearing on the cause of applicant's claimed injury to provide percentages of causation, but PQME Dr. Taylor does not provide the reasoning linking the factors to the injury. This defect is not cured by referring to clinical expertise and years of training. Further, PQME Dr. Taylor provided opinions based on an incomplete record and appears to have relied on an incorrect history. In summary, PQME Dr. Taylor's opinions are not substantial evidence. (Hegglin, supra, pp. 169-170.)
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.
Provided causation percentages for industrial and non-industrial factors but failed to explain reasoning, relied on incomplete record and incorrect history, thus opinions were not substantial evidence.
The PQME's opinions lacked explanation and were based on incomplete and inaccurate information, making them not substantial evidence.
From the decision · page 11evidence. PQME Dr. Taylor discusses many contributing factors he believes have a bearing on the cause of applicant's claimed injury to provide percentages of causation, but PQME Dr. Taylor does not provide the reasoning linking the factors to the injury. This defect is not cured by referring to clinical expertise and years of training. Further, PQME Dr. Taylor provided opinions based on an incomplete record and appears to have relied on an incorrect history. In summary, PQME Dr. Taylor's opinions are not substantial evidence. (Hegglin, supra, pp. 169-170.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 3600, 3202.5, 5705, 3208.3(b)(1); South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408; Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162; Dep't of Corr. v. Workers' Comp. Appeals Bd., (Garcia) (1999) 76 Cal. App. 4th 810
To be compensable, an injury must arise out of and occur in the course of employment; employee bears burden of proving injury AOE/COE by preponderance of evidence; for psychiatric injuries, applicant must show employment events were predominant cause.
The Board applied these standards to evaluate whether the psychiatric injury was compensable and whether the PQME's opinions constituted substantial evidence.
From the decision · page 7To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee 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 [80 Cal.Comp.Cases 489]; Lab. Code, § 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, 416-417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)
What proof carried it
The evidence the panel weighed, by kind.
PQME Dr. Taylor's opinions lacked explanation and were based on incomplete and inaccurate information
From the decision · page 11evidence. PQME Dr. Taylor discusses many contributing factors he believes have a bearing on the cause of applicant's claimed injury to provide percentages of causation, but PQME Dr. Taylor does not provide the reasoning linking the factors to the injury. This defect is not cured by referring to clinical expertise and years of training. Further, PQME Dr. Taylor provided opinions based on an incomplete record and appears to have relied on an incorrect history. In summary, PQME Dr. Taylor's opinions are not substantial evidence. (Hegglin, supra, pp. 169-170.)
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
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