Oakland - A new California Workers’ Compensation Institute (CWCI) study shows that almost half of all litigated claims in the LA Basin are cumulative trauma (CT) claims that involve physical or mental...
LexisNexis has selected some recently issued noteworthy IMR decisions that illustrate the criteria that must be met to obtain authorization for a variety of different medical treatment modalities. LexisNexis...
CALIFORNIA COMPENSATION CASES
Vol. 89, No. 2 February 2024
A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions...
By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board
In the 1785 poem, To a Mouse , Robert Burns observed that the best...
By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board
The struggle is real. How and when should Workers’ Compensation Judges (WCJs) apply the statute...
I. How NOT to Request That the Record Be Developed
In the Noteworthy Panel Decision (NPD) of Quintero v. PBC Holding Corporation dba Commercial Cleaning Systems, 2015 Cal. Wrk. Comp. P.D. LEXIS 610 [2015 Cal. Wrk. Comp. P.D. LEXIS 610], applicant, Ms. Quintero, was extremely disappointed after her AOE/COE trial (i.e., a trial as to whether her injury arose out of or occurred in the course of employment). On 7/20/2015, the judge issued a “take nothing,” while she was hoping for an award of industrial injury to her hands, back, knees, lower extremities, feet, and shoulders.
How did this happen?
(Publisher’s Note: Citations link to lexis.com; bracketed cites link to Lexis Advance.)
Lack of credibility? Post termination defense? Lack of substantial evidence? Turns out credibility was not an issue. Neither was the post-termination defense. And apparently the judge found the medical reports submitted into evidence did constitute substantial evidence, since he relied upon them for his finding of “take nothing.”
The crux of the issue for applicant was her argument that the record had not been sufficiently developed. She asserted that the medical evaluators should have been provided with additional medical records to consider. On the day of trial, applicant asked for a continuance, so that the record could be developed to allow the medical evaluator an opportunity to review the additional records and issue a supplemental report in support of her claim. The judge denied this request. The trial went forward and a “take nothing” issued.
Applicant filed a Petition for Reconsideration requesting that the finding of “Take Nothing” be vacated and that the record be developed so that more favorable medical reports could be submitted to the judge at a subsequent trial.
The WCAB denied this request.
By way of explanation, the WCAB stated,
“Here, applicant's Petition is basically a stream of consciousness—there is not one specific reference to the record, nor one reference to legal authority to support her factual and legal contentions. Applicant's petition is therefore skeletal in that it is unsupported by the necessary references to the case record and relevant principles of law, and therefore, we will deny the Petition. (See Cal Code Regs tit. 8 §10846 [R10846].) We also decline to vacate the Order and return this matter to the trial level for further development of the medical record.”
II. Always Comply With the Regulations When Filing a Petition for Recon Requesting the Record Be Developed
Petitions for Reconsideration are often viewed as a second chance to “get it right.” But the WCAB has been consistent in ruling that, unless good cause justifies otherwise, the record must be fully developed prior to the Mandatory Settlement Conference per Labor Code § 5502(d)(3) [LC 5502], and most certainly before trial.
When filing a Petition for Reconsideration on this issue (or on any issue for that matter), it is essential to comply with the following regulations:
If applicant had complied with these regulations, would her result have been different? Perhaps not, but her odds of success would have been exponentially increased. Over the past several decades, the courts have issued opinions interpreting the conflict in the law between judge’s duty to close discovery at the Mandatory Settlement Conference (MSC) (Lab. Code § 5502(d)(3) [LC 5502]) and the judge’s duty to develop the record to ensure all decisions are based on substantial evidence (Lab. Code §§ 5701 and 5906 [LC 5701, LC 5906]), but there is still no consensus.
III. How Do Judges Balance Their Duty to Develop the Record With Their Duty to Close Discovery?
The most recent case law, including the Quintero case, seems to turn on one simple question. Did the party asserting the argument to develop the record exercise due diligence prior to the trial? In the Quintero case, the WCAB acknowledged the above conflict, but found the following evidence of lack of due diligence on behalf of applicant, weighed heavily against allowing the applicant to develop the record.
The WCAB concluded,
“Although applicant was in possession of the February 18, 2015 PQME Dr. Tsou report, and the medical records of Dr. McCoy for months before the mandatory settlement conference, and knew from the Pre-Trial Conference Statement that defendant intended to use them to defeat AOE/COE, applicant did nothing to cure the medical evidence on her own. Given that applicant was in a position to obtain her own medical records from Mexico, and defendant was not, the failure to obtain those records to ‘cure’ the report of PQME Dr. Tsou is irreconcilable with applicant's own best interest. In addition, if the report of PQME Dr. Tsou is not substantial evidence, as applicant claims, then it was not substantial evidence at the time it issued. Even so, we find nothing in the record that indicates applicant took the deposition of PQME Dr. Tsou or requested a supplemental report from him.
It is a maxim of jurisprudence in California that, ‘No one can take advantage of his wrong.’ (Civ. Code, § 3517 [CC 3517.]) We therefore find that applicant has not shown good cause for an order to further develop the record. (See County of Sacramento v. Workers’ Comp. Appeals Bd. (1999) 68 Cal.App.4th 1429 [68 Cal.App.4th 1429].)”
The result seems harsh, considering that a lack of review of all pertinent medical records, as in this case, would normally render the evaluating physician’s report inadmissible as evidence, or at the very least might be deemed as not constituting “substantial evidence.” Labor Code § 4628(a)(2) [LC 4628] requires that the evaluating physician shall review and summarize pertinent “prior medical records.” 8 Cal. Code Reg. § 10606 [R 10606] has a similar provision.
NOTE: Curiously, there is a conflict between the Labor Code and the Regulations as to what is the recourse for failure to comply with the minimum mandatory standards for a medical-legal report. Labor Code § 4628(e) states that failure to comply with the requirements of this section shall make the report inadmissible as evidence…,” while 8 Cal. Code Reg. § 10606 states, “… failure to comply with the requirements of this section will not make the report inadmissible but will be considered in weighing the evidence.” (emphasis added) Normally, the Labor Code will trump a regulation in the event of a conflict, but it didn’t seem to do so in the Quintero case. However, even if the regulation trumps the Labor Code and the report is admitted into evidence, if it lacks the minimum mandatory elements, it will be difficult for a judge to rely on the report for any legal determinations, even though the judge did so in the Quintero case.
Best practices dictate that parties be mindful of medical evidence that is not properly developed. Parties should be scrutinize reports to make sure that all requests from the evaluating physician (such as for additional medical records, or for diagnostic tests) have been provided promptly. In addition, if a physician has been ambiguous on a relevant issue, such as the determination of whole person impairment, that issue should be addressed and clarified, either through a supplemental report or the doctor’s deposition.
If caught unaware after opposing counsel files a DOR, make sure to lodge your objection promptly with the court. Bring the issue to the court’s attention at the MSC. If the judge agrees to continue the case to develop the record, the party asserting the position of developing the record might want to request a finding that there was no lack of due diligence on their behalf. Likewise, if the judge denies the motion to continue the trial to develop the record, the party in opposition to developing the record may want to request a finding that there was a lack of due diligence. Either way, a finding on this issue might well be helpful to the WCAB commissioners in determining whether to uphold or reverse a judge on this issue, in the event a Petition for Reconsideration is filed.
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