In a victory for disabled workers, the California Court of Appeals 6th District has upheld the decision in the Guzman case (actually known as Milpitas Unified School District v. WCAB and Joyce Guzman).
While not final/final, its starting to look like the Almaraz/Guzman II decision of the WCAB will survive.
Workerscompzone is on vacation. But when I return to my office I’ll be analyzing Guzman in a video point-counterpoint format I’ll be launching soon with a leading defense attorney. More about that another time.
The Court of Appeals has yet to decide to hear the Almaraz II case, and in fact may never grant a writ to hear the case.
Unless a conflict develops between different California Court of Appeal districts, it’s hard to imagine the California Supreme Court wading into this controversy. After all, the California courts have extended great deference to the WCAB.
So, it would appear that Guzman is here to stay.
This pretty much undercuts some of the self-serving experts who packaged themselves as keepers of the pure AMA Guides flame.
The decision by the 6th District makes it clear that doctors and judges are not bound to administer cookie cutter justice based on shibboleths of a narrow AMA Guides approach.
As the 6th District notes, “we take a broader view of both its text and the statutory mandate”. The 6th District noted:
“We cannot expand the statutory mandate by changing the word “incorporate” to “apply exclusively.” Nor can we read into the statute a conclusive presumption that the descriptions, measurements and percentages set forth in each chapter are invariably accurate when applied to a particular case. By using the word “incorporation,” the Legislature recognized that not every injury can be accurately described by the classifications designated for the particular body part involved. Had the Legislature wished to require every complex situation be forced into preset management criteria, it would have used different terminology to compel strict adherence to those criteria for every condition.”
Also worth noting in the opinion:
-the 6th district notes that “The Guides ratings do provide a standardized basis for reporting the degree of impairment, but those are “consensus-derived estimates,” and some of the given percentages are supported by only limited research data. (Guides. pp.4,5.)”
-the Court also notes that “The Guides also cannot rate syndromes that are “poorly understood and are manifested only by subjective symptoms.”
This leads the 6th District to note the importance of clinical judgement and the concepts of Chapters 1 and 2 of the Guides.
At the end of the day under Guzman, the “how and why” expressed by the physician will be critical. The 6th District notes that the physician’s medical opinion must constitute substantial evidence.
Defendants will argue that Guzman applies only to extraordinary and complex cases. The decision notes that “Given the comprehensiveness and precision attendant in the chapters pertaining to each system, in most cases a WCJ will credit ratings based strictly on the chapter devoted to the body part, region, or system affected.”
So we can expect defendants to focus on challenging doctors as to the how any why they are using other descriptors under the Guides. For example, the Court noted “if Guzman’s carpal tunnel syndrome is adequately addressed by the pertinent sections of Chapter 16, an impairment rating that deviates from those provisions will properly be rejected by the WCJ”.
On the other hand, noting in this decision prevents a physician from using other portions of the Guides where the Guides would otherwise not describe the condition qdequately. That’s where we’ll see doctors using their clinical judgement.
In the coming year or two we’ll see the WCAB setting forth parameters in some cases as to how far doctors can go in using other charts, tables or methods. And we’ll see in some cases how much how and why analysis the examining physician must provide before successfully departing from the “straight AMA” analysis.
But for the moment, chalk this up as a big win for disabled workers.
Here’s a link to a pdf of the Guzman II decision:
http://www.dir.ca.gov/wcab/EnBancdecisi … ep2009.pdf
And here’s a link to the decision of the 6th District:
http://www.courtinfo.ca.gov/opinions/do … 034853.PDF
Category: Understanding the CA WC system