ADJ9687495 — California WCAB decision

What the panel ordered

Findings, Award and Order issued by WCJ on August 30, 2021 affirmed except amended to include injury AOE/COE and future treatment to right hip.

Petition for reconsideration granted to further study factual and legal issues; matter returned to trial level and resubmitted; decision after reconsideration issued.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold February 9, 2021.

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.

Psyche AOE/COEDefendant prevailedlumbar spine · right hip · psyche

The Appeals Board found that the physical injury was significant but not catastrophic based on factors including treatment intensity, ultimate outcome, and impact on activities of daily living, relying on the orthopedic AME's opinion and applicant's deposition testimony.

From the decision · page 6In the instant case, the first three factors are the only that apply to this matter. First, with respect to the intensity of treatment, applicant underwent two surgeries to his lower back within five months, and had at least some pain relief following the fusion. He will need significant further treatment in the form of physician visits, physical therapy, medications and injections. Applicant also related in volume 3 of his deposition transcript that he may need additional surgery to remove hardware from his spine. This factor weighs the closest to catastrophic among the three applicable categories here.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant underwent two lumbar surgeries and requires ongoing treatment including physician visits, physical therapy, medications, and injections.

Favours Defendant prevailed

Indicates significant but not catastrophic injury severity.

From the decision · page 6In the instant case, the first three factors are the only that apply to this matter. First, with respect to the intensity of treatment, applicant underwent two surgeries to his lower back within five months, and had at least some pain relief following the fusion. He will need significant further treatment in the form of physician visits, physical therapy, medications and injections. Applicant also related in volume 3 of his deposition transcript that he may need additional surgery to remove hardware from his spine. This factor weighs the closest to catastrophic among the three applicable categories here.

Applicant uses a cane regularly and sometimes a walker, but orthopedic AME did not recommend these devices or place applicant in the highest impairment category.

Favours Defendant prevailed

Supports finding that injury is not catastrophic.

From the decision · page 6Regarding the second Wilson factor (the ultimate outcome of the physical injury), applicant's outcome is somewhat poor, and there are factors which weight [sic] both for and against a catastrophic condition. He was placed in Category IV (with Category V being the most severe) at Table 15-3 of the AMA Guides for his lumbar spine injury. He uses a cane regularly, and sometimes uses a walker. On the other hand, Dr. Renbaum did not specifically recommend the use of a cane or a walker. He also did not place applicant in the highest level of Table 15-3, and did not provide an analogous Almaraz/Guzman rating over and above the strict AMA Guides level of impairment.

Applicant can perform many activities of daily living independently, including walking short distances, using the bathroom, lifting 20-30 pounds, and sitting for over an hour.

Favours Defendant prevailed

Shows significant but not catastrophic impact on ADLs.

From the decision · page 6Regarding the third factor applicable here, the deposition testimony of applicant establishes that the majority of his physical difficulties relate to his ambulation. He is, however, still able to walk on his own for short distances, albeit with difficulty. He is able to use the bathroom on his own, and can lift 20-30 pounds, sit for over an hour, and feels like everybody else when he is sitting down or stationary. There is no indication that he is unable to groom himself or take care of his general personal needs. Overall, the third factor shows that the physical injury has a significant, but not catastrophic, impact on applicant's ability to perform ADL's.

ADJ9687495 · December 3, 2021

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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