What the panel ordered
The WCAB granted reconsideration, rescinded the WCJ's decision, and ordered that the applicant is entitled to medical treatment for the left knee caused by the industrial injury.
Applicant sought reconsideration of the WCJ's Joint Findings and Order of March 4, 2024, which denied medical treatment for the left knee; the WCAB granted reconsideration, rescinded the WCJ's decision, and issued a new decision granting treatment for the left knee.
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 WCAB found that the Compromise and Release agreement did not bar medical treatment for the left knee because the right knee injury caused a need for left knee treatment, which is reasonably required to cure or relieve the effects of the injury.
From the decision · page 3Thus, the WCJ erred in finding that the Compromise and Release agreement barred a finding for further medical treatment to the left knee under the circumstances of this case. While applicant may have had a left knee condition that was alleged to be industrial but not included as compensable in the 2018 settlement, the medical reporting of primary treating physician orthopedist Tomas Saucedo, M.D. states that, years after the settlement, favoring of the stipulated right knee injury contributed to the need for left knee treatment. (November 10, 2021 report at p. 1 ["However as a result of favoring his right knee he has notably increased pain and discomfort to his left knee and at this time indicates that his left knee pain has become more pronounced and
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The Compromise and Release agreement did not include the left knee as a compensable injury but left future medical treatment open for the right knee and other body parts.
Favours Applicant prevailed
This ambiguity allowed the WCAB to find that medical treatment for the left knee caused by the right knee injury was not barred by the settlement.
Medical reports from treating orthopedist Tomas Saucedo, M.D. indicated that favoring the right knee injury caused increased pain and need for treatment in the left knee.
Favours Applicant prevailed
This medical evidence supported the finding that left knee treatment was industrially related and compensable.
From the decision · page 3Thus, the WCJ erred in finding that the Compromise and Release agreement barred a finding for further medical treatment to the left knee under the circumstances of this case. While applicant may have had a left knee condition that was alleged to be industrial but not included as compensable in the 2018 settlement, the medical reporting of primary treating physician orthopedist Tomas Saucedo, M.D. states that, years after the settlement, favoring of the stipulated right knee injury contributed to the need for left knee treatment. (November 10, 2021 report at p. 1 ["However as a result of favoring his right knee he has notably increased pain and discomfort to his left knee and at this time indicates that his left knee pain has become more pronounced and
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.
The applicant's favoring of the stipulated right knee injury caused increased pain and need for treatment in the left knee, making left knee treatment industrially related.
The medical reporting of primary treating physician orthopedist Tomas Saucedo, M.D. states that favoring the right knee injury contributed to the need for left knee treatment.
From the decision · page 3Thus, the WCJ erred in finding that the Compromise and Release agreement barred a finding for further medical treatment to the left knee under the circumstances of this case. While applicant may have had a left knee condition that was alleged to be industrial but not included as compensable in the 2018 settlement, the medical reporting of primary treating physician orthopedist Tomas Saucedo, M.D. states that, years after the settlement, favoring of the stipulated right knee injury contributed to the need for left knee treatment. (November 10, 2021 report at p. 1 ["However as a result of favoring his right knee he has notably increased pain and discomfort to his left knee and at this time indicates that his left knee pain has become more pronounced and
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code 4600, subdivision (a)
Medical treatment that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury is compensable under Labor Code 4600, subdivision (a).
The WCAB applied this standard to find that treatment to the left knee caused by the right knee injury is compensable.
From the decision · page 4more very difficult to engage in routine activities of daily living as a result of his increased pain to that extremity."].) Since the right knee injury was accepted and it caused a need for medical treatment to the left knee, treatment to the left knee constitutes care "that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury." (Lab. Code, § 4600, subd. (a).)
What proof carried it
The evidence the panel weighed, by kind.
Medical reporting of primary treating physician Tomas Saucedo, M.D. indicating that favoring the right knee injury caused increased pain and need for treatment in the left knee.
From the decision · page 3Thus, the WCJ erred in finding that the Compromise and Release agreement barred a finding for further medical treatment to the left knee under the circumstances of this case. While applicant may have had a left knee condition that was alleged to be industrial but not included as compensable in the 2018 settlement, the medical reporting of primary treating physician orthopedist Tomas Saucedo, M.D. states that, years after the settlement, favoring of the stipulated right knee injury contributed to the need for left knee treatment. (November 10, 2021 report at p. 1 ["However as a result of favoring his right knee he has notably increased pain and discomfort to his left knee and at this time indicates that his left knee pain has become more pronounced and
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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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