What the panel ordered
Petition for Reconsideration by SIBTF is denied except that the finding is amended to find applicant is not eligible for SIBTF benefits.
Petition for Reconsideration filed by Subsequent Injuries Benefits Trust Fund (SIBTF) was granted to study legal and factual issues; WCJ prepared a Report and Recommendation to deny the Petition; the Appeals Board issued an Opinion and Decision After Reconsideration affirming the WCJ's Report except amending the finding on eligibility for SIBTF benefits.
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.
Applicant's subsequent injury resulted in 100% permanent disability, which under Labor Code section 4751 and relevant case law disqualifies eligibility for SIBTF benefits because the subsequent injury must result in partial permanent disability, not total.
From the decision · page 4However, SIBTF benefits are not meant to displace an employer's liability. When an injured worker's subsequent injury results in 100% permanent disability, there is no need for SIBTF benefits to fill in the gap between an injured worker's entire permanent disability and the percentage of disability caused by the employment. Indeed, section 4751 explicitly provides that the subsequent additional permanent disability be partial. (§ 4751.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's subsequent injury resulted in 100% permanent disability.
Favours Defendant prevailed
This fact disqualifies applicant from receiving SIBTF benefits under Labor Code section 4751, which requires the subsequent injury to result in partial permanent disability.
From the decision · page 4However, SIBTF benefits are not meant to displace an employer's liability. When an injured worker's subsequent injury results in 100% permanent disability, there is no need for SIBTF benefits to fill in the gap between an injured worker's entire permanent disability and the percentage of disability caused by the employment. Indeed, section 4751 explicitly provides that the subsequent additional permanent disability be partial. (§ 4751.)
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.
AME for the parties in the industrial injury.
From the decision · page 2The subsequent industrial injury was to the cervical, thoracic and lumbar spines, right upper extremity, left upper extremity, and to the psyche. The parties in the industrial injury utilized Steven Feinberg, M.D., as an Agreed Medical Examiner. The parties entered into a Compromise and Release to resolve the subsequent industrial injury.
Provided medical evidence establishing significant disability from the industrial injury greater than the underlying claim, with orthopedic permanent disability ratings leading to 139% after adjustment for age and occupation.
His opinion on orthopedic permanent disability was used to calculate the overall subsequent injury permanent disability.
From the decision · page 53. The subsequent industrial injury of 06/05/2008 resulted in orthopedic permanent disability pursuant to the opinions of Dr. Newman, as follows:
Provided psychiatric permanent disability rating with a GAF score of 50, resulting in 30% WPI, 60% attributed to the industrial injury, rating 32% overall psychiatric permanent disability.
His psychiatric disability rating was combined with orthopedic ratings to determine total permanent disability.
From the decision · page 54. The subsequent industrial injury of 06/05/2008 resulted in psychiatric permanent disability based on the opinions of Dr. Kirz, with a GAF score of 50 which results in a 30% WPI, with 60% attributed to the industrial injury, which rates as follows:
Provided medical evidence supporting applicant's significant disability from the industrial injury.
His medical evidence was part of the additional reporting relied upon to establish disability.
From the decision · page 2Applicant then sought benefits from SIBTF, and rather than rely on AME Feinberg, Applicant further developed the medical evidence and utilized reporting from Michael Newman, D.C., Joshua Kirz, PhD., and Bruce Dreyfuss, M.D. Based on this additional reporting Applicant established that she had significant disability resulting from the industrial injury, in an amount greater than what had been established in the underlying industrial claim.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code
Labor Code section 4751
Defines eligibility criteria for SIBTF benefits, including the requirement that the subsequent injury results in partial permanent disability, not total.
Todd v. Subsequent Injuries Benefits Trust Fund (2020) 85 Cal. Comp. Cases 576
Clarifies the elements required to establish eligibility for SIBTF benefits under Labor Code section 4751.
From the decision · page 3In Todd v. Subsequent Injuries Benefits Trust Fund (2020) 85 Cal. Comp. Cases 576, 581- 582 [2020 Cal. Wrk. Comp. LEXIS 35], we stated that in order to be entitled to SIBTF benefits, an employee must prove the following elements:
What proof carried it
The evidence the panel weighed, by kind.
Applicant's subsequent injury resulted in 100% permanent disability, which is a key factor in denying SIBTF benefits.
From the decision · page 4However, SIBTF benefits are not meant to displace an employer's liability. When an injured worker's subsequent injury results in 100% permanent disability, there is no need for SIBTF benefits to fill in the gap between an injured worker's entire permanent disability and the percentage of disability caused by the employment. Indeed, section 4751 explicitly provides that the subsequent additional permanent disability be partial. (§ 4751.)
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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