In workers’ compensation cases, proving causation between an injury or condition and an employee’s workplace activities is a critical step. However, the burden of proof in these cases is unique to the workers’ compensation system, relying on the standard of “reasonable medical probability.” A recent decision by the Workers’ Compensation Appeals Board (WCAB) underscores the importance of ensuring that medical opinions are aligned with this standard. At Yrulegui & Roberts, we closely monitor decisions like these to provide the best defense strategies for our clients.
Case Overview: Industrial Causation and Parkinson’s Disease
In Wies v. State of California, 2024 Cal. Wrk. Comp. P.D. LEXIS 224, the WCAB reviewed a case involving a cumulative trauma claim where the applicant, an auto technician, alleged that workplace exposures caused Parkinson’s Disease. The Workers’ Compensation Judge (WCJ) initially found in favor of the applicant, but the defendant successfully petitioned for reconsideration. The WCAB granted the petition and returned the case to the trial level for further development of the medical record.
Key Issues Highlighted in the Decision
The WCAB’s decision emphasized the following critical points:
- The Legal Standard in Workers’ Compensation Cases:
- Unlike scientific research, which may rely on statistical confidence levels or certainty, workers’ compensation cases require causation to be established by reasonable medical probability. This means it is “more likely than not” that workplace factors contributed to the injury or condition.
- Role of Medical Evidence:
- In this case, the Panel QME neurologist, Dr. Ezekiel Fink, relied heavily on scientific studies with stricter thresholds for causation, potentially applying a higher standard than necessary.
- The WCAB instructed the QME to reassess causation under the appropriate legal standard, using clinical judgment and a holistic review of all evidence.
- Duty to Develop the Record:
- When the medical evidence is incomplete or insufficient to support a finding, the WCAB has a constitutional obligation to ensure the record is fully developed.
- This includes clarifying medical opinions and ensuring they address the appropriate legal questions.
Implications for Workers’ Compensation Defense
For employers and insurance carriers, this decision is a reminder of the importance of scrutinizing medical evidence and ensuring that QMEs and AMEs are properly educated on the legal standards applicable in workers’ compensation cases. Some key takeaways include:
- Educating Medical Experts: Defense attorneys should work with medical professionals to ensure they understand the “reasonable medical probability” standard and how it differs from scientific certainty.
- Challenging Insufficient Opinions: Medical reports that rely too heavily on statistical studies or fail to consider clinical judgment and other risk factors can and should be challenged.
- Leveraging the WCAB’s Duty to Develop the Record: When medical evidence is incomplete, the defense should advocate for further record development to avoid decisions based on insufficient or flawed testimony.
How Yrulegui & Roberts Can Help
At Yrulegui & Roberts, we specialize in defending employers and insurance carriers in complex workers’ compensation cases. Our team has extensive experience challenging medical opinions that fail to meet the correct legal standard and ensuring that our clients’ interests are vigorously protected.
If you have questions about a workers’ compensation claim or need assistance with a case involving disputed medical evidence, contact us today. We are here to help you navigate California’s workers’ compensation system with confidence.
Contact us at Yrulegui & Roberts to learn more about how we can assist with your workers’ compensation defense needs.
