What the panel ordered
Petition for Reconsideration denied.
Petition for Reconsideration filed by Defendant Benchmark Insurance Company for Illinois Midwest Insurance Company challenging the Findings and Award issued on 4-28-22, following record development and supplemental reports from QME Dr. Lee Silver and PTP Dr. Mark Spoonamore.
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.
The WCJ found the reports of Dr. Spoonamore to be better reasoned, more persuasive, and substantial evidence supporting industrial causation of the cervical spine injury, while Dr. Silver's reports lacked persuasive and credible medical reasoning and were not substantial evidence.
From the decision · page 4Upon very close scrutiny of the complex and voluminous complete medical record submitted before and after development of the record, with the trial briefs submitted, the undersigned found the reports of Dr. Mark Spoonamore, read with his deposition transcript, are the better reasoned and more persuasive.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Spoonamore's reports are better reasoned, more persuasive, and supported by a complete medical record and detailed job duties history.
Favours Applicant prevailed
These reports were found to be substantial evidence supporting industrial causation of the cervical spine injury, leading to denial of reconsideration.
From the decision · page 4Upon very close scrutiny of the complex and voluminous complete medical record submitted before and after development of the record, with the trial briefs submitted, the undersigned found the reports of Dr. Mark Spoonamore, read with his deposition transcript, are the better reasoned and more persuasive.
Dr. Silver's reports lacked persuasive and credible medical reasoning, did not adequately explain inconsistencies or significance of MRI findings, and deferred final causation determination to the trier of fact.
Favours Applicant prevailed
This lack of substantial evidence led to rejection of Dr. Silver's opinions and supported the denial of reconsideration.
From the decision · page 5The PQME did not order any further testing to the cervical spine or do a detailed examination of the cervical spine in the three times he examined the applicant in 2011, 2014 and 2017. The PQME did not offer any explanation for the complaints of pain or the findings by other doctors of injury to the cervical spine, or mention the deterioration shown in the repeated MRI results over time. The QME does not adequately or persuasively explain why he considers the MRI's are not significant. The QME does not rebut the findings or reasoning of Dr. Spoonamore finding industrial injury to the cervical spine. Dr. Silver offers no arguments, facts, medical records or evidence to explain the pre-surgery condition of the applicant's cervical spine and the constant pain at that time.
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.
Credible and persuasive causation of cervical spine injury based on complete medical record and detailed job duties history; reports and cross-examination are better reasoned and substantial evidence.
The WCJ found Dr. Spoonamore's opinions to be better reasoned and more persuasive than Dr. Silver's, supporting industrial causation of the cervical spine injury.
From the decision · page 6Dr. Spoonamore makes a credible and persuasive case for cervical spine injury during the course of the continuous trauma period with the more complete and accurate medical record, and a well- reasoned causation determination based on the applicant's accurate history of the strenuous duties of employment over time. Taken together, his reports and the cross-examination transcript are the better reasoned opinions and substantial evidence.
Reports not supported by persuasive and credible medical reasoning; did not adequately explain inconsistencies or significance of MRI findings; deferred final causation determination to trier of fact.
The WCJ found Dr. Silver's reports lacked persuasive and credible medical reasoning and were not substantial evidence.
From the decision · page 5The reports of PTP Dr. Spoonamore and QME Dr. Silver are widely divergent. The undersigned made a detailed and careful review of the 13 reports by Dr. Silver comprised of 10 record reviews, 3 examination reports and a cross-examination transcript. It appears Dr. Silver based his initial opinion on the clinical findings of his first examination, which was all he was given, but did not later adequately or persuasively explain why he did not consider any of the large body of contradictory evidence subsequently received to be material.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408; Hegglin v. Workmen's Comp. App. Bd. (1971) 4 Cal.3d 162; Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399
A medical opinion must be predicated on reasonable medical probability and set forth reasoning, not mere conclusions, to constitute substantial evidence.
The WCJ applied these standards to evaluate the medical opinions of Dr. Spoonamore and Dr. Silver regarding causation of cervical spine injury.
From the decision · page 4"In order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416§ 417, 419, 33 Cal. Comp. Cases 660.) Also, a medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (Hegglin v. Workmen's Comp. App. Bd. (1971) 4 Cal.3d 162, 169, 36 Cal. Comp. Cases 93.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399, 407, 33 Cal. Comp. Cases 647.)"
What proof carried it
The evidence the panel weighed, by kind.
Dr. Spoonamore's detailed job duties history and complete medical record review supporting causation
From the decision · page 6Dr. Spoonamore also considered the applicant's job duties in detail. The [] female, aged [] at the end of employment, gave physicians an unrebutted and consistent history of working for seven years, six days a week, lifting and carrying up to 50 pounds, washing dishes, stocking merchandise, cleaning the kitchen and restrooms of a restaurant, washing walls, sweeping the parking lot and emptying the trash, Ex. 3 Dr. Spoonamore 8-13-17, Ex. 5 Dr. Spoonamore 8-20-21. In his reports and at his cross-examination, the doctor credibly found industrial causation based on that record of the job duties, and the nature and extent of injury based on the complete and accurate medical record. Dr. Spoonamore notes the basic job duties, but again does not discuss what impact those duties may have had on the applicant.
Dr. Silver's failure to explain inconsistencies and significance of MRI findings
From the decision · page 5The PQME did not order any further testing to the cervical spine or do a detailed examination of the cervical spine in the three times he examined the applicant in 2011, 2014 and 2017. The PQME did not offer any explanation for the complaints of pain or the findings by other doctors of injury to the cervical spine, or mention the deterioration shown in the repeated MRI results over time. The QME does not adequately or persuasively explain why he considers the MRI's are not significant. The QME does not rebut the findings or reasoning of Dr. Spoonamore finding industrial injury to the cervical spine. Dr. Silver offers no arguments, facts, medical records or evidence to explain the pre-surgery condition of the applicant's cervical spine and the constant pain at that time.
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About this page
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