Medical opinion rejected for 'incorrect legal theory'

California fire and life safety officer claims multiple injuries from work

Medical opinion rejected for 'incorrect legal theory'

If a doctor bases their opinion on an incorrect legal theory or on an inadequate medical history, like in a situation where there are not enough medical records to review, the tribunal will not consider the opinion substantial evidence.

The defendant in the case of Stroub vs. State of California, Department of General Services, legally uninsured, administered by State Compensation Insurance Fund employed the applicant as a fire and life safety officer.

The applicant claimed injuries to the following body parts

  • bilateral shoulders, right elbow, and right hand on Dec. 6, 2007 (in case number ADJ7689184)
  • bilateral elbows, bilateral hands and wrists, right fingers and thumb, and left thumb on Apr. 22, 2010 (in case number ADJ77978930)
  • bilateral shoulders, bilateral elbows, right arm/upper arm, and bilateral hands and wrists on Jan. 21, 2015 (in case number ADJ9882820)

Dr. Joel Renbaum, the orthopedic agreed medical examiner, evaluated the applicant, took her history, reviewed her medical record, and made diagnoses. The doctor determined that her condition was permanent and stationary from June 2015 to August 2019.

In case number ADJ9882820, the workers’ compensation administrative law judge found the applicant entitled to temporary disability indemnity benefits for certain specified periods. In case number ADJ7798930, the judge found the applicant entitled to additional temporary disability benefits for the period from Aug. 1, 2014 to Aug. 27, 2014.

The defendant asked for reconsideration. In case number ADJ9882820, the defendant argued that the applicant was not entitled to temporary disability indemnity as a result of taking time off work to attend medical treatment after her condition became permanent and stationary.

In case number ADJ7798930, the defendant alleged that the applicant was not entitled to additional temporary disability benefits beyond the 104-week maximum under section 4656(c)(2) of California’s Labor Code.

Decision partly rescinded

In case number ADJ9882820, a panel of the Workers’ Compensation Appeals Board of California returned the matter to the workers’ compensation judge to conduct further proceedings and to issue a new decision. The panel determined that Dr. Renbaum’s reports were not substantial evidence to support an award of temporary disability indemnity benefits.

Dr. Renbaum failed to provide medical records for review, failed to address the inconsistencies in his findings about the applicant’s disability status, and based his opinion that the applicant was entitled to temporary disability indemnity for “time off work to seek medical care” on an incorrect legal theory, the panel concluded.

The work status notes of two other doctors failed to describe the medical treatment that the applicant received and failed to explain why she was taken off work for the days listed, the panel said. These notes were not substantial medical evidence for the purpose of determining whether the applicant was temporarily totally disabled as a result of the treatment, the panel added.

Decision partly affirmed

In case number ADJ7798930, the panel agreed with the judge’s findings and award. The panel said that the parties’ stipulations were binding on them unless they could show good cause for them to withdraw from their agreements.

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