Source: https://behavioralhealthce.com/index.php?option=com_courses&task=view&cid=160
Timestamp: 2019-04-18 14:57:07+00:00

Document:
Substantiating a mental-mental psychiatric work injury in such cases as the injured worker (IW) being threatened by an armed gunman in the course of a robbery or witnessing a drunk driver hitting a pedestrian is obvious and straightforward. However, evaluators are often asked to determine the validity of a mental-mental “stress” claims in more ambiguous situations such as individuals claiming work stress due to such things as: being “overworked”, being yelled at by a supervisor in front of others, being passed over for promotion for some “unfair” reason, being given too much work, etc. These situations are much less clear and one of the most critical issues is whether the situation is a Good Faith Personnel Action (which is not a work injury) or an actual mental-mental psychiatric injury. In these cases, the QME/AME should complete a Rolda Analysis, including all evidence that supports various conclusions one way or another.
This course will begin with an overview of the case examples that are presented. The course will then review some of the case findings relevant to this discussion (Rolda v. Pitney Bowes and Fujimoto v. Caliber Collision Centers). The two cases are then presented. The first case is a successful claim of a mental-mental work injury. The second case is a non-successful mental-mental work injury claim.
The following “facts in brief” are outlined in the Defense Advocacy Letter as follows: Applicant has filed an Application for Adjudication of Claim alleging a cumulative trauma for the period of 9/10/13 - 9/10/14 alleging psychiatric injury due to her students being out of control (She is a high school teacher). She filed two separate claim forms. She alleges a specific mental-mental injury incident on 9/10/14 and psychiatric CT of 9/10/13 - 9/10/14. The claim has been denied based upon Good Faith Personnel action pursuant to Labor Code Section 3208.3 (H).
In addition, at the time of the applicant’s deposition, she testified that she was employed as a science teacher for the Yosemite Unified School District, 9th-12th grade. Her symptoms included vomiting, body shakes, poor sleep, and high blood pressure. Applicant attributed these symptoms to the poor behavior of her students. However, she did testify that the vomiting has stopped since she has been on summer vacation. She is also a diabetic and testified that her body will shake when she is hungry. Again, she testified to no longer suffering from the body shakes since she is on summer vacation. Lastly, her sleep has also improved during the summer break. The applicant also suffers from depression, anxiety and a number of psychological symptoms which she attributes to the work environment.
In a letter from the Defense, it is noted that the applicant was employed by Springhill Suites as a banquet waiter. According to the letter, he filed an application alleging injury for the period of 3/16/2010 through 3/16/2011 to the head, chest, neck, back, multiple body parts and nervous system/psyche. The letter notes that at the end of the cumulative trauma period he was 38-years-old. The letter states that in the applicant’s deposition, it was confirmed that he had dual employment with other employers during the course of his employment with Springhill Suites. The letter goes on to state that injury to the nervous/psyche is in dispute and denied by the defendant. The injury claim is being denied based upon Good Faith Personnel action pursuant to Labor Code Section 3208.3 (H).
The letter goes on to state that the employer witnesses denied the allegations set forth by the applicant’s deposition. According to the employer, there was a verbal exchange on December 11, 2010 between the applicant and a banquet captain over a gratuity issue. According to the employer’s witnesses, the applicant’s behavior was unprofessional and inappropriate. Therefore, a disciplinary action was prepared which the applicant declined to sign.
The letter goes on to state that on 9/22/2012, according to the employer, the applicant witnessed an attempted theft of a coworker’s sunglasses and did not report such. The letter states that the applicant was later complicit in the denial by the coworker of wrongdoing when the item, the sunglasses, were found in that person’s pocket. The letter states that the applicant was also accused by another coworker of having used offensive language towards another worker. Mr. Johnson received a written warning and was advised of the importance of treating everyone with respect and acting professionally at all times. He was also advised that failure to do so created a negative environment for his fellow associates. Mr. Johnson resigned from his employment on 12/21/2012.
The letter goes on to state that I have been provided with medical records including the report of Tony Malone, Ph.D., dated 6/13/2012. Dr. Malone diagnosed an Adjustment Disorder with Depressed Mood and a Personality Disorder including paranoid and antisocial trends. The letter goes on to state that the comprehensive psychological evaluation completed by Dr. Malone concluded that the applicant suffered no psychological injury as a result of his employment with Springhill Suites. Rather, he was found to have a Preexisting Mixed Personality Disorder with Paranoid and Antisocial Trends.
The letter goes on to request that I address the usual issues in dispute and determine whether Mr. Johnson has found employment since he left from Springhill Suites.
Whether the lawful, non-discriminatory, good faith personnel actions were the “substantial” cause (35% to 40%) of the psychiatric injury.
Case Summary of Rolda v. Pitney Bowes, Inc.
A salesman alleged that he had sustained psychiatric injury while employed by Pitney Bowes from September 1995 to September 17, 1997. This was claimed to be due to his mistreatment by his supervisor relative to the salesman's clients and territory. In June of 2000, a WCJ found there was an award for a psychiatric work injury (mental-mental) and it was not due to good faith personnel action (GFPA). Due to the importance of the case (and this issue), it was reassigned to the WCAB (2001) as a whole for an en banc decision. The decision is reviewed as follows. The decision itself can be found HERE and should be reviewed as part of the course. Please pay particular attention to page 6 of the findings (“Discussion”).
To determine whether a claimed psychiatric injury is compensable or barred, in Rolda v. Pitney Bowes (2001), the WCAB laid out a multilevel four-step analysis that is “required when a psychiatric injury alleged and the defense of a lawful, nondiscriminatory, good faith personnel action has been raised”.
The first determination to be made is whether the alleged psychiatric injury involves actual events of employment. This is a factual/legal issue for the workers’ compensation judge (WCJ) to determine.
The second determination is whether the actual events caused the psychiatric injury. This determination requires medical evidence. According to Lab. Code § 3208.3, the causation threshold is either "predominant as to all causes combined" or substantial where the injury resulted from a violent act. "Predominant as to all causes combined," although not defined in the statute, is defined as work-related causes that constitute greater than 50% of the total causes of the injury, whereas a substantial cause is defined as at least 35% to 40% of the causation from all sources combined. Dep't of Corr. v. Workers' Comp. Appeals Bd., 76 Cal. App. 4th 810 (1999).
The third determination is whether any of the actual events were personnel actions that were lawful, nondiscriminatory and in good faith. This is a factual/legal issue for the WCJ to determine.
The fourth determination is whether the lawful, nondiscriminatory, good faith personnel actions were a substantial cause of the psychiatric injury. This determination requires medical evidence.
The WCAB ultimately concluded that the present case (Rolda) did not comply with the four-step analysis necessary to determine the compensability of the salesman's alleged psychiatric injury and the matter was returned to the trial level for further proceedings.
As can be seen, completing a proper Rolda Analysis is quite involved. Therefore, the QME/AME should be sure that his/her decisions are based upon all of the appropriate evidence. This might include, but not be limited to, a transcript of the applicant's deposition, applicant's medical history and records, transcripts of witness statements, and other relevant contents enclosed in the applicant's personnel file as well as any other non-medical information that may bear on industrial or non-industrial causation.
This case illustrates how the WCJ will rely on competent medical evidence (the QME/AME findings), along with other data. It also underscores why it is important to think in terms of percentage contribution of causation to the psychiatric symptoms (e.g. GFPA, allowed work stress, non-industrial issues, etc.). It underscores the importance for the psyche medical-legal evaluator to identify each alleged actual event and separately assign each event its own percent of causation. The decision itself can be found HERE and should be reviewed as part of the course. Please pay particular attention to pages 4-5.
In Fujimoto v. Caliber Collision Centers (2014), a WCAB panel denied an applicant’s Petition for Reconsideration in a case where a workers’ compensation judge found that applicant did not sustain a compensable psychiatric injury.
Applicant, an auto body technician, filed a CT claim through 9/2/10 alleging injury to the psyche due to harassment by co-workers. The parties agreed to use Myron Nathan, M.D. as an AME. Dr. Nathan found that 90% of applicant’s psyche injury was caused by work related stress. He issued a report and the parties proceeded to trial, but at the time of trial the WCJ ordered the parties to obtain a “definitive report” from the AME consistent with the Rolda framework.
The AME then issued two supplemental reports. In the first, he stated that actual events of employment were the predominant cause and that these events were not personnel actions. In his next report, he stated that he did not believe that applicant was “100% credible and reliable.” The case proceeded again to trial and applicant testified to various allegations of harassment (placement of dead rats on his toolbox, co-workers drilled a hole in the bathroom and used a camera to watch him use the bathroom and uploaded it onto the internet, sexually explicit graffiti on the bathroom wall, tampering with his toothbrush, installation of tape recorders in applicant’s car, etc.).
[Please] provide a supplemental report that describes in detail, in accordance with Rolda, all the workplace and all the nonindustrial related events and/or issues that combined caused the Applicant’s psychological injury. You are then to assign a percentage of causation separately to each individual work-related and/or non-industrial event(s) and/or issue(s) that, when combined, equal 100% of the causation of the Applicant’s psychological injury.
You are not to combine percentages as to any multiple factors and/or issues, either industrial or non-industrial. It will ultimately be up to me to decide which workplace activities are actual events (i.e., which of the event(s) described by the Applicant happened or not) and whether those events that I have deemed to be actual events are otherwise legitimate, non-discriminatory, good faith personnel actions. Based on this, I can determine if the actual events of employment, if added together, will result in them being the predominant cause (i.e., more than 50%) of the Applicant’s psychological injury, and whether those actual causes were substantially caused (i.e., 35% to 40%) by lawful, nondiscriminatory, good faith personnel actions.
In response, the AME issued a report assigning a separate percentage of causation to 11 different events of employment (totaling 90% industrial causation). He only assigned 4% causation to the obscene graffiti on the bathroom wall. The WCJ found the defense witnesses to be credible whereas he found applicant to be “patently dishonest” and that the alleged work related stressors were “facetious and delusional.” The WCJ determined that the obscene graffiti (4% causation) was the only actual event of employment that occurred. Thus, the predominant cause threshold was not met and the WCJ issued a “take nothing”.
Reconsideration was denied and the Panel emphasized that a WCJ’s credibility determination is given great weight. They also noted that applicant offered no other evidence to corroborate the alleged actual events other than his testimony. This case illustrates the roles of the WCJ and the AME in applying the Rolda analysis. It underscores the importance for the psyche medical-legal evaluator to identify each alleged actual event and separately assign each event its own percent of causation.
Please review the following case examples. The first two reports include the initial evaluation and supplemental report establishing a work-related mental-mental psychiatric injury. The initial evaluation can be found HERE and the supplemental report can be found HERE.
In the second case, a Rolda Analysis did not support the conclusion that a psychiatric injury had occurred (rather GFPA). That report can be found HERE and the supplemental can be found HERE.

References: v. 
 v. 
 v. 
 v. 
 § 3208
 v. 
 v.