Court Determines Meaning Of Prima Facie For QIW

A medical report that defendants consider to be less than adequate, according to an appellate court will be sufficient to award applicant retroactive vocational rehabilitation maintenance allowance benefits.

The applicant in this case was a clerk who suffered an admitted injury, for which only permanent disability of only 6 Vi % was awarded. Applicant also filed for rehabilitation relying on a medical report that indicated that he could no longer perform his job as a clerk. Neither the applicant or the defendant filed any additional medicals with the Rehabilitation Unit. The Rehabilitation Unit found the applicant QIW and ordered services and benefits be provided.  Defendant appealed and included several other medical reports with the appeal. The Judge determined the applicant was not QIW and the applicant did not appeal that issue.  The applicant did appeal to receive retroactive benefits between the application and the determination of not being a QIW.

In Industrial Indemnity v. WCAB the court stated that an applicant will be paid benefits during the “evaluation” period when the applicant has made a prima facie showing of QIW. In the present case the defendant argued mat the Judge correctly ruled that applicant has not made a prima facie case.

This court noted that when reviewing for “substantial evidence”, a medical opinion which is based on a false or an inaccurate or incomplete history may not satisfy that standard.

The Court looked at this specific medical report relied on by applicant in this case and Court indicated that on its face the report was perfectly adequate.

The ruling indicated that”… a prima facie case is shown when a party presents evidence which, if unrebutted and credited, would justify a finding in his favor….But if the evidence is later rebutted, or is not credited by the trier of fact, mat does not deprive it of its original character….we mink it is obvious mat a determination of whether or not a showing meets a required ‘prima facie” standard is made without reference to contrary evidence and without evaluating credibility.” The Court went on to say that”… a showing which qualifies as sufficient ‘on its face’ is not deprived of mat qualification simply because later events, and the submission of additional evidence, persuade the trier of fact to reject it in making a final determination.”

Therefore, once the applicant has a report identifying him as a QIW, benefits will not be denied during the evaluation period simply because the employer has a better or more credible report. The Court also indicated that applicant has no duty to submit any medical other mat the one he/she is relying on.

The Court only inferred mat a finding of bad faith may defeat the claim for retroactive benefits. What may be inferred is that only deliberate lies or sub rosa films may defeat the claim for benefits.

Case: Pena V. W.C.A.B.

Harvey Brown
3501 Jamboree Rd. Suite 602
Newport Beach, CA 92660

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