City of Jackson v. Workers' Compensation Appeals Board
11 Cal. App. 5th 109
| Cal. Ct. App. | 2017Background
- Christopher Rice, a police officer, sustained a cumulative cervical injury ending April 22, 2009, with diagnoses of cervical radiculopathy and degenerative disc disease.
- QME Dr. Sloane Blair examined Rice (pre- and post-surgery) and apportioned causation among four categories: City employment, prior employment, personal activities, and personal history (including genetics).
- Based on medical literature on heritability of disc degeneration, Dr. Blair attributed 49% of Rice’s permanent disability to personal history/genetics and 17% to each of the other three categories.
- The ALJ accepted Dr. Blair’s apportionment as to genetics (49%) but found some other apportionments insufficient (not at issue here).
- The Workers’ Compensation Appeals Board granted reconsideration and ordered an unapportioned award, concluding (1) genetics is an impermissible immutable factor for apportionment, (2) Dr. Blair impermissibly apportioned causation of injury rather than disability, and (3) the QME’s opinion was not substantial medical evidence.
- The Court of Appeal annulled the Board’s decision, holding apportionment to genetics may be proper, Dr. Blair apportioned disability (not merely injury), and her opinion constituted substantial medical evidence.
Issues
| Issue | Rice's Argument | City of Jackson's Argument | Held |
|---|---|---|---|
| Whether apportionment to genetics/heredity is permissible | Genetic apportionment lacks patient-specific familial proof and no genetic test; thus not substantial evidence | Apportionment may be based on nonindustrial pathology/heritability supported by medical literature | Genetics/heritability can be a proper apportionment basis under post‑SB 899 law; Board erred in treating genetics as categorically impermissible |
| Whether Dr. Blair apportioned causation of the injury (impermissible) rather than causation of the permanent disability | Apportionment to genetics improperly addresses causation of injury, not disability | Dr. Blair apportioned the extent of the permanent disability (limitations/wage loss) and tied percentages to causes of that disability | Court: Dr. Blair apportioned causation of disability, not merely causation of the injury; Board’s conclusion was incorrect |
| Whether Dr. Blair’s 49% apportionment to genetics is substantial medical evidence | Opinion is speculative without family history or genetic testing | Opinion relied on peer‑reviewed studies showing high heritability and explained reasoning; framed as reasonable medical probability | Dr. Blair’s reports satisfied Escobedo criteria: based on reasonable medical probability, cited studies, adequate exam/history, and explained reasoning — substantial evidence supports 49% |
| Proper remedy for Board’s denial of apportionment | N/A (challenge to Board decision) | Board’s reconsideration and order for unapportioned award should be upheld | Court annulled Board’s order and remanded with directions to deny reconsideration (i.e., reinstate apportionment) |
Key Cases Cited
- Brodie v. Workers’ Comp. Appeals Bd., 40 Cal.4th 1313 (explaining SB 899 changed apportionment focus to causation of disability)
- Zemke v. Workers’ Comp. Appeals Bd., 68 Cal.2d 794 (pre‑SB 899 rule that employer took employee as found; illustrative of prior law)
- Acme Steel v. Workers’ Comp. Appeals Bd., 218 Cal.App.4th 1137 (apportionment to congenital degeneration upheld where substantial medical evidence showed nonindustrial contribution)
- Braewood Convalescent Hosp. v. Workers’ Comp. Appeals Bd., 34 Cal.3d 159 (defining substantial evidence standard)
- Allied Compensation Ins. Co. v. Industrial Acci. Com., 211 Cal.App.2d 821 (distinguishing injury versus disability elements)