Workers' compensation claim granted reconsideration

Appeals Board of California steps in, reversing judge's order

Workers' compensation claim granted reconsideration

Section 5313 of California’s Labor Code requires a workers’ compensation administrative law judge to make and to file findings upon all facts involved in a controversy, as well as an award, order, or decision determining the parties’ rights.

In Pleasant vs. Millard Lineage Logistics; Ace American Insurance Company, the applicant brought three applications for adjudication of claim, which were consolidated. The first two applications covered the issues of whether he sustained an injury arising out of and in the course of employment on Sept. 10, 2017 and who should be liable for the self-procured medical treatment.

The third application listed the additional issues of whether an additional panel qualified medical evaluator in orthopedics was needed for the applicant’s cumulative trauma claim and whether Dr. Schames’s reporting was substantial medical evidence.

In April, the workers’ compensation administrative law judge found that the applicant did not sustain injury arising out of and in the course of his employment to his back and feet (in the first application) and to his jaw, mouth, teeth, and shoulders (in the second application). The judge also found that Dr. Schames’s reporting was not substantial medical evidence.

Read more: Investigation into worker death reveals no compensation insurance

Both the applicant worker and the defendant company sought reconsideration of the judge’s April findings and order. The applicant argued that there was sufficient evidence establishing that work was a contributing cause of his injury to his shoulders and lumbar spine, while the defendant asserted that the applicant did not sustain a cumulative trauma injury from Sept. 8, 2017 through Sept. 15, 2017.

The judge issued a report recommending that the Workers’ Compensation Appeals Board of California grant reconsideration and return the matter to the trial level for a continued development of the record.

The panel of the appeals board granted reconsideration, rescinded the April order, and returned the matter to the judge for further proceedings and for the issuance of a new decision on all issues raised.

The panel held that the judge failed to address whether the applicant sustained an industrial injury with respect to the third application – which involved a claim for a cumulative trauma injury through Sept. 15, 2017 to the applicant’s back, shoulder, and foot – and failed to determine the other issues submitted in that application.

Those seeking reconsideration from a workers’ compensation judge’s or the Workers’ Compensation Appeals Board’s final order should provide specific and detailed grounds for why the decision was unlawful or unjust, as well as the issues to be addressed.

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