Zenith Ins. Co. v. Workers' Comp. Appeals Bd

The Court of Appeal in Zenith Ins. Co. v. Workers' Comp. Appeals Bd. (2008) 159 Cal.App.4th 483 (Cugini), provided guidance on the factors to consider in determining which PDRS to apply. Cugini suffered an injury to his back in 2004. He was referred for treatment and an MRI was performed. Cugini treated with various physicians, who prescribed medications and discussed the need for back surgery. Following an orthopedic consultation, Dr. Fenton prepared a report dated December 28, 2004, stating, "I am a treating physician for the above-referenced applicant. There is a reasonable medical probability that permanent disability exists as a result of the injury or injuries for which I am treating this patient. I will describe that disability further in a subsequent report." Also in 2004, Cugini was examined by a neurosurgeon who in a report of that same year recommended additional diagnostic studies but also recommended surgery. (Cugini, at p. 488, fn. 2.) Cugini underwent surgery and his condition was declared permanent and stationary in 2005. The court concluded that the determination whether Dr. Fenton's report or other qualifying medical reports constituted substantial medical evidence of permanent disability under section 4660, subdivision (d), should be based on the entire record. (Cugini, supra, 159 Cal.App.4th at p. 495.) The Cugini court distinguished the facts before it from those in State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (2007), noting that prior reports from Cugini's primary treating physician stated the history, facts and diagnosis of a herniated disc, which was confirmed by the diagnostic studies and supported the need for back surgery. These factors, the court concluded, together with a report of a neurosurgeon who concurred with the primary treating physician as to the need for surgery, constituted substantial medical evidence as to the existence of permanent disability prior to January 1, 2005. (Cugini, supra, 159 Cal.App.4th at p. 495.)