Genetic Apportionment in a QME Report: Connecting Medical Studies to Your Disability

A QME report may cite genetics without a genetic test, but the word genetics is not itself an explanation for reducing permanent disability. The report needs a supported connection between the medical literature, the condition identified in your own examination and records, and the disability being apportioned. City of Jackson v. Workers’ Comp. Appeals Bd. (Rice), 11 Cal. App. 5th 109 (2017), accepted one such explanation; it did not assign a genetic percentage to everyone with disc degeneration.

First check whether the ordinary apportionment rules apply

Labor Code §4663 bases apportionment on causation of permanent disability. Subdivision (c) requires the physician to explain the approximate industrial and other causation percentages. Subdivision (e), however, excludes injuries or illnesses covered by its expressly listed presumptive statutes from subdivisions (a), (b), and (c). Those exclusions concern the covered condition and statutory requirements, not merely a person’s job title. Counsel should resolve that question before using a general genetic-apportionment analysis.

Separate a supported inference from an unexplained percentage

Read the opinion as three connected explanations. First, which pathology or condition does the evaluator identify in your records? Second, why does the cited study help explain that condition in someone with your history and findings? Third, how does that condition contribute to the present permanent disability, and why did the doctor choose the stated percentage?

On the Rice record, the sequence was: Identify the condition through examination, history, and imaging; explain the relevant studies; connect their reasoning to the diagnosed condition and its disabling effects; and justify the selected allocation. Rice, slip op. at 12–14. A study about susceptibility to an injury does not automatically establish the causes of the resulting disability. Conversely, the absence of earlier symptoms does not automatically defeat an opinion about an underlying condition’s present contribution. The relevant question is what the evidence supports in this person, not whether genetics is always permissible or always forbidden.

The Rice court accepted the evaluator’s combined reports, which included the medical history, examination, diagnostic imaging, identified studies, and explanation of the apportionment choice. A different report may lack one of those connections even when it uses the same scientific vocabulary. See Rice, slip op. at 10–14.

A study percentage is not your disability percentage

In Rice, counsel asked the doctor about a hypothetical separating patients with exclusively genetic causes from patients with exclusively environmental causes. The doctor rejected that framing, and the court distinguished the literature’s genetic-contribution estimates from the suggested division into separate groups of patients. Rice, slip op. at 12–13.

The evaluator’s explanation still mattered. She identified the diagnosed condition in Rice’s history, examination, and imaging; explained the research she relied on; and selected a figure below the literature estimates for the reasons stated in her reports. The court accepted that combined explanation. It did not direct another evaluator to reuse her percentage or replace individual medical reasoning with a study statistic. Ask for the explanation behind your report’s chosen percentage in writing.

Identify the limitations the doctor is actually apportioning

In Rice, the court distinguished repetitive movement at work from the lasting pain and functional restrictions. The latter included limits on sitting, lifting, and vibratory activities. The court read the evaluator’s explanation as addressing those disability consequences rather than simply assigning causes to the work event. Rice, slip op. at 9–10.

For your report, place the stated limitations next to each causation explanation. A diagnosis alone may not explain the relationship. A history of smoking or an inherited predisposition also cannot be treated as a disability percentage merely because it appears somewhere in the medical chart.

Prepare questions tied to the report’s actual evidence

• Save the original and every supplemental report. Mark where the evaluator changed a percentage and the explanation for the change.
• Identify the separate factors inside a personal-history category. The disputed 49% in Rice included genetics, brief smoking history, and epicondylitis; it was not a finding of 49% attributable solely to DNA.
• Keep the named studies or the report’s bibliographic references alongside the explanation. Ask what the research measured and why it applies to the diagnosed condition.
• Compare the history used by the evaluator with the medical and employment records. Identify a specific discrepancy rather than declaring the entire history unreliable.
• Ask what each factor contributes to the present functional limitations and what supports the percentage. Preserve the physician’s answer rather than substituting a lay medical conclusion.

The two 17% allocations for earlier work and personal activities in Rice were rejected at trial for inadequate explanation and were not the issue resolved on writ review. A percentage’s appearance in the same report as an accepted allocation does not make all its other allocations valid. Rice, slip op. at 4.

A later panel illustrates why the causal explanation still matters

In Monti v. MasTec, Inc., No. ADJ19727180 (WCAB July 20, 2026), the panel cited Rice while rejecting the employer’s attempt to obtain apportionment based on risk factors without sufficient evidence of disability causation. The panel affirmed a 100% permanent-disability award on that particular heart-attack record. It is a panel decision with persuasive reasoning, not binding precedent establishing a universal result for heart conditions. Slip op. at 7–10.

Counsel can evaluate whether the report needs a targeted supplemental question, further examination of the evaluator, or another procedural response. The correct response depends on the complete record and the procedural stage; the existence of a genetic percentage alone does not decide the claim.

Read our analysis of Rice and its 49% personal-history allocation for the court’s reasoning. Our workers’ compensation practice page explains how to contact the firm about a California claim.