ADJ12011890 · June 14, 2021

The WCJ's findings that the decedent's fatal motor vehicle accident on January 23, 2019 was a compensable consequence of his industrial injury were supported by credible evidence including medical reports and testimony, outweighing defendant's contrary billing records and depositions.

From the decision · page 6In this case, the primary issue presented at trial was whether the decedent's January 23, 2019 motor vehicle accident returning from a medical treatment appointment was causally connected to an industrial injury on July 16, 2018 to his lumbar spine, right hip and right knee, resulting in a compensable consequence.

Decedent's fatal motor vehicle accident occurred returning from a medical treatment appointment for an industrial injury.

Favours Applicant prevailed

This established the causal connection for compensability of death.

From the decision · page 1the applicant's husband, Michael the applicant, died on January 23, 2019 in a motor vehicle accident on the 14 Freeway, 14 to 15 miles from his home, two exits away from the off ramp to return home from Valencia [S]ports Medicine and Rehabilitation. He had received physical therapy and chiropractic care for an industrial low back injury sustained when, after fighting a fire, he slipped, twisted his knee and fell to the ground. Valencia Sports Medicine and Rehabilitation was 30 minutes from the applicant's home. the applicant left his home at 8:45 a.m. to 8:50 a.m., and arrived at 9:25 a.m. for his appointment at 9:30 a.m. He left at 10:45 a.m. and sustained his fatal motor vehicle accident at 11:17 a.m.

Medical report of Dr. Browne showed treatment for low back pain on January 23, 2019, supporting compensability.

Favours Applicant prevailed

The WCJ found this report more reliable than defendant's contrary evidence.

From the decision · page 6The Defendant relied on the billing codes contained in the health insurance claim forms of Valencia Sports Medicine & Rehabilitation for treatment of cervical and thoracic spine complaints from October 19, 2018 to January 23, 2019. [Defendant's Exhibits "C" and "D"] However, this was contradicted by the medical report of Dr. Bowne who provided the Applicant chiropractic treatment for his low back pain on January 23, 2019.

Credible testimony of Carol Moore about common practice of self-procured medical treatment to avoid workers' compensation restrictions.

Favours Applicant prevailed

This testimony undermined the defendant's reliance on billing records.

From the decision · page 6In addition, based on the credible testimony of Carol Moore, the patient care coordinator for the Los Angeles County Firefighters Local 1014 Health and Welfare Plan, it was a common practice for injured workers to surreptitiously self-procure medical treatment privately under its health insurance plan to avoid the restrictions of the workers' compensation utilization review system, thereby calling into question the validity of the billing codes contained in the health insurance claim forms of Valencia Sports Medicine & Rehabilitation.

WCJ's credibility determinations given great weight as he observed witness demeanor.

Favours Applicant prevailed

Supports the reliability of the applicant's evidence over defendant's.

From the decision · page 2We have given the WCJ's credibility determinations great weight because the WCJ had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500].) Furthermore, we conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determinations. (Id.)

Provided medical report supporting that the decedent received chiropractic treatment for low back pain on January 23, 2019, supporting compensability of the subsequent fatal accident.

The WCJ found Dr. Browne's medical report more reliable and persuasive than defendant's billing records and depositions.

From the decision · page 6The Defendant relied on the billing codes contained in the health insurance claim forms of Valencia Sports Medicine & Rehabilitation for treatment of cervical and thoracic spine complaints from October 19, 2018 to January 23, 2019. [Defendant's Exhibits "C" and "D"] However, this was contradicted by the medical report of Dr. Bowne who provided the Applicant chiropractic treatment for his low back pain on January 23, 2019.

McAllister v. Workers' Comp. Appeals Bd. (1968) 33 Cal. Comp. Cases 660; Rosas v. Workers' Comp. Appeals Bd. (1993) 58 Cal. Comp. Cases 313; South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 80 Cal. Comp. Cases 489

An applicant must show industrial causation is reasonably probable and work was a contributing cause.

Applied to determine compensability of death as a consequence of industrial injury.

From the decision · page 5An applicant is not required to prove the existence of an industrial injury beyond a reasonable doubt. Instead, an applicant merely needs to present substantial evidence showing that "industrial causation is reasonably probable" [McAllister v. Workers' Comp. Appeals Bd. (1968) 33 Cal. Comp. Cases 660, 665; Rosas v. Workers' Comp. Appeals Bd. (1993) 58 Cal. Comp. Cases 313, 322] and that work was a "contributing cause." [South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 80 Cal. Comp. Cases 489, 495]

Laines v. Workmen's Comp. Appeals Bd. (1975) 40 Cal Comp. Cases 365

Injury sustained en route to medical treatment for industrial injury is compensable if visit is based on statutory obligation.

Applied to find injury en route to medical treatment compensable.

From the decision · page 6"Where the visit to the doctor is based on the statutory obligation of the employer to furnish and the employee to submit to medical examination and nondangerous treatment, an injury sustained in the course of such a visit should be held to be an injury arising out of and in the course of employment within the meaning of [] 3600 of the Labor Code." [Laines v. Workmen's Comp. Appeals Bd. (1975) 40 Cal Comp. Cases 365, 369 (internal citations omitted.)]

Beaty v. Workers' Comp. Appeals Bd. (1978) 43 Cal. Comp. Cases 444

Subsequent injury is compensable consequence if industrial injury was a contributing factor.

Applied to find the fatal accident a compensable consequence of the industrial injury.

From the decision · page 5In addition, a subsequent injury will constitute a compensable consequence of an industrial injury if the industrial injury was a contributing factor in the occurrence of the subsequent injury. [Beaty v. Workers' Comp. Appeals Bd. (1978) 43 Cal. Comp. Cases 444, 448]

Sutter Solano Medical Center v. Workers' Comp. Appeals Bd. (2018); Barela v. Leprino Foods (2009)

Treatment need not be authorized to be compensable if it cures or relieves effects of industrial injury.

Applied to find self-procured treatment compensable.

Credible testimony of Carol Moore about common practice of self-procured medical treatment to avoid workers' compensation restrictions

From the decision · page 6In addition, based on the credible testimony of Carol Moore, the patient care coordinator for the Los Angeles County Firefighters Local 1014 Health and Welfare Plan, it was a common practice for injured workers to surreptitiously self-procure medical treatment privately under its health insurance plan to avoid the restrictions of the workers' compensation utilization review system, thereby calling into question the validity of the billing codes contained in the health insurance claim forms of Valencia Sports Medicine & Rehabilitation.

WCJ's credibility determinations given great weight as he observed witness demeanor

From the decision · page 2We have given the WCJ's credibility determinations great weight because the WCJ had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500].) Furthermore, we conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determinations. (Id.)