The Shift in Apportionment: Analyzing the Recent En Banc Decisions
The landscape of apportionment in California workers' compensation law is undergoing a subtle but significant transformation.


Chris Lyle
Co-Founder & CEO

A two-percentage-point swing in a permanent disability rating can translate into tens of thousands of dollars in indemnity exposure — and in California's workers' compensation system, those numbers get litigated every single day before the WCAB. That isn't hyperbole; it's arithmetic. With maximum PD indemnity rates climbing steadily and complex multi-body-part cases regularly producing six-figure exposure variances, no contested rating dispute is small. [1]
Permanent disability rating disputes are among the most technically contested battlegrounds in California workers' compensation. From apportionment fights under Labor Code §4663 to conflicting WPI assessments across QME and AME reports, the path from an initial rating to a final WCAB determination is rarely straightforward. The AMA Guides (5th Edition), the PDRS, and a dense body of En Banc and panel decisions from the WCAB create a framework that rewards practitioners who know the terrain cold. [2]
This guide breaks down every critical stage of a PD rating dispute — how ratings are established, challenged, and adjudicated at the WCAB — and shows how practitioners who move faster and cite smarter consistently win better outcomes for their clients.
The statutory backbone of any PD dispute runs through Labor Code §§4660, 4660.1, 4663, and 4664. These sections define what gets rated, how it gets rated, and how apportionment applies once a rating is established. For injuries on or after January 1, 2005, §4660.1 mandates use of the AMA Guides 5th Edition as the clinical foundation for Whole Person Impairment assessments. The Permanent Disability Rating Schedule (PDRS) then converts raw WPI percentages into adjusted PD ratings using age, occupation, and date-of-injury modifiers — a mechanical process that nonetheless produces enormous disputes in application. [1]
Pre- vs. post-SB 899 injuries remain a live issue in cases with long-latency conditions or reopened claims. The applicable rating schedule can produce dramatically different outcomes on identical facts, which means confirming your date of injury is not a clerical formality — it's a threshold tactical decision that frames every subsequent argument.
The QME and AME reports form the medical-legal foundation upon which every PD dispute is built or dismantled. Without a well-developed medical-legal record establishing causation, WPI, apportionment, and the nexus between industrial injury and disability, there is nothing for a WCJ to adjudicate.
In represented cases, the choice between a QME panel and an agreed medical evaluator is one of the highest-leverage tactical decisions in the entire case. An AME's opinion — negotiated by both parties and examining both sides' theories — is presumptively given substantial weight and tends to narrow the scope of dispute rather than expand it. That makes AME selection a critical negotiation, not a routine stipulation.
A QME panel report, by contrast, triggers specific procedural rights under Labor Code §4062.2 that practitioners must actively preserve. The cover letter sent to the QME is not a formality — it is the document that frames the medical-legal questions the evaluator will answer. Practitioners who send generic cover letters and then complain about unhelpful WPI opinions have only themselves to blame. Targeted, legally precise questions about causation, apportionment methodology, and alternative rating methods under Almaraz/Guzman set the table for a favorable opinion.
When to push for an AME versus accepting a QME panel depends on your facts, your evaluator pool, and your read on which party benefits from a more collaborative process. Defense counsel in cases with clean apportionment facts often prefer AMEs who will address prior degenerative pathology head-on. Applicant-side practitioners with strong Almaraz/Guzman facts sometimes prefer QME panels where they control the specialty selection more directly.
The WCAB's substantial medical evidence standard is the quality filter through which every medical-legal opinion must pass. Conclusory opinions — where a physician states a WPI number without explaining the clinical basis, or apportions without analyzing causation — do not survive scrutiny on reconsideration. [2]
To meet the threshold, an evaluating physician must address causation, apportionment, and WPI with reasoned analysis tethered to objective clinical findings, diagnostic studies, and the applicable methodology under the AMA Guides. Key En Banc decisions have sharpened this standard considerably, and practitioners who can map gaps in the opposing evaluator's opinion to specific deficiencies identified in controlling En Banc authority arrive at trial with a ready-made reconsideration argument baked in from the start.
Rating disputes typically ignite at three trigger points: the initial QME or AME report, the DEU rater's summary rating, and at trial before a WCJ. Each trigger point requires a different response, and failing to preserve your objection at the earliest possible stage can waive arguments you'll desperately need later. [3]
Common flashpoints include apportionment percentages that are either over- or under-applied, WPI calculation errors resulting from incorrect table selection under the AMA Guides, body part omissions where compensable conditions weren't rated, psychiatric add-ons, and sleep or sexual dysfunction claims asserted as compensable consequences of industrial injury.
The formal objection process is where records are made or lost. Every objection to a QME or AME report must be specific, timely, and legally grounded. A vague objection that the report is "inadequate" without identifying the precise deficiency — wrong table, no causation analysis, apportionment without Escobedo compliance — gives a WCJ very little to work with and gives opposing counsel a roadmap around your attack.
Apportionment is the most heavily litigated dimension of PD disputes. Under §4663, apportionment to non-industrial causation requires substantial medical evidence — not speculation, not a physician's naked assertion that degenerative changes contributed to the disability. The Escobedo standard demands that the evaluating physician explain the basis for any apportionment opinion with specificity: what percentage is industrial, what percentage is non-industrial, and why — supported by clinical findings, history, and reasoning. [4]
The overlap between §4663 (causation apportionment) and §4664 (prior award apportionment) creates layered exposure for applicants and layered opportunity for defense. Section 4664 allows the defense to reduce a current PD award by the percentage of any prior PD award for the same body part, and the presumption of continuing disability under §4664(b) shifts the burden onto the applicant to overcome it. Experienced defense counsel exploit both statutes simultaneously, stacking apportionment arguments to drive the net PD rating down.
On the applicant side, the attack on apportionment opinions typically focuses on whether the physician's analysis conflates the existence of a pre-existing condition with actual disability caused by that condition — a distinction the WCAB has repeatedly emphasized. Degenerative findings on imaging do not automatically translate into apportionable disability without a reasoned causal analysis.
Psychiatric claims and add-on conditions represent some of the highest-risk, highest-reward territory in PD disputes. The 6-month rule under Labor Code §3208.3(d) creates a heightened threshold for psychiatric claims filed within six months of hire, requiring the applicant to show that actual events of employment were the predominant cause of the psychiatric injury.
Almaraz/Guzman opens the door to alternative rating methods within the AMA Guides for psychiatric WPI, allowing evaluators to move beyond the default GAF-based methodology when it produces an inaccurate result. Sleep dysfunction and sexual dysfunction as compensable consequences of industrial injury require specific evidentiary showings — medical evidence establishing industrial causation for the secondary condition, not merely the primary orthopedic injury. Defense teams that challenge these add-ons with targeted supplemental questions and deposition cross-examination of the evaluator consistently reduce inflated WPI assessments.
The procedural roadmap from dispute to decision runs through the Declaration of Readiness to Proceed, the mandatory settlement conference, and trial before a WCJ. Understanding what each stage is actually for — and what you must accomplish at each one — separates practitioners who control the process from those who react to it.
Stipulations with Request for Award lock in PD ratings and preserve future medical rights while closing the indemnity portion of the claim. Compromise and Release settles everything, including future medical, in exchange for a lump sum. In PD disputes where the rating is genuinely contested, the C&R valuation is downstream of your ability to establish or undercut the medical-legal record — which means every deposition, every supplemental report request, and every DEU consultative rating request is ultimately a settlement leverage move.
The WCJ's Opinion on Decision is the document that frames reconsideration. A WCJ who credits the defense evaluator over the applicant's physician without explaining why — or who applies apportionment without addressing the Escobedo standard — has handed you your reconsideration argument on a plate.
The 20-day deadline under Labor Code §5903 is absolute. Missing it is fatal, and there is no equitable exception. The clock runs from service of the WCJ's order, decision, or award, and practitioners who calendar this deadline the moment they receive adverse findings are the ones who preserve their clients' appellate rights. [2]
A Petition for Reconsideration must contain specific assignments of error, supporting legal authority, and precise citations to the record. General complaints about the outcome are not assignments of error. The WCAB's three-member panel will grant reconsideration, deny it, or rescind and return the case to the WCJ for further proceedings. A grant means the WCAB is taking a hard look — it doesn't mean you've won. A rescind and return is often the most tactically complex outcome because it reopens the record.
When the WCAB denies reconsideration, the escalation path runs to the California Court of Appeal via a Writ of Review under Labor Code §5950. The 45-day deadline to file the writ petition from the reconsideration denial is equally unforgiving.
En Banc decisions bind all WCJs and WCAB panels. They are the rulings that reshape practice overnight and that no practitioner can afford to miss. [2] Panel decisions are persuasive but not binding — and knowing when to lead with a favorable panel decision versus when to distinguish an unfavorable one is a skill that separates competent practitioners from exceptional ones.
The landmark En Banc decisions every PD practitioner must have command of include Almaraz/Guzman (alternative rating methods under the AMA Guides), Ogilvie (rebuttal of the PDRS DFEC adjustment through vocational evidence), Milpitas Unified School District v. WCAB (apportionment methodology), and Hikida (the limits of apportionment where industrial injury causes a condition that requires treatment). These decisions are not historical artifacts — they are active weapons and shields deployed in every contested PD case.
The practitioner who arrives at the MSC with every relevant En Banc and panel decision already mapped to the specific facts of the case wins more often. That's not a motivational statement — it's an empirical observation about how WCAB litigation actually works.
Almaraz/Guzman I and II established that physicians are not imprisoned by the default rating table in the AMA Guides chapter that governs their specialty. They may use any chapter within the Guides to arrive at a more accurate WPI, provided they explain why the standard method produces an inaccurate result and why the alternative method better captures the actual functional impairment. [2]
This doctrine is the single most powerful tool in contested PD litigation — for both sides. On the applicant side, it allows evaluators to reach higher WPI ratings for conditions where the default methodology undervalues genuine functional loss. On the defense side, it can be used to challenge evaluators who reach default ratings that overstate impairment in the absence of objective clinical support. The key is that the physician's explanation must be substantive and tied to specific clinical findings — not a boilerplate statement that the standard method is inadequate.
The Ogilvie rebuttal doctrine operates in parallel: when a party believes the PDRS's diminished future earning capacity adjustment fails to accurately reflect the injured worker's actual diminished capacity, vocational evidence can rebut the schedule's presumptive adjustment. The bar for that vocational evidence is substantial evidence — methodologically sound, individually tailored, and responsive to the defense's transferable skills arguments.
The defense playbook centers on apportionment under §§4663 and 4664, challenges to add-on conditions as non-industrial, and attacks on WPI methodology where the evaluator applied the wrong table, used Almaraz/Guzman without sufficient justification, or failed to address prior awards. Supplemental QME/AME report requests, targeted deposition cross-examination, and DEU consultative ratings are the primary tactical instruments. [4]
The applicant playbook leverages Almaraz/Guzman to maximize ratings, deploys Ogilvie vocational expert testimony to rebut the PDRC DFEC factor, and attacks apportionment opinions that lack the Escobedo analysis required for substantial evidence. Vocational experts who can demonstrate actual labor market data showing the injured worker's diminished earning capacity in their specific occupation and geographic market are worth their weight in MSC leverage.
Cross-referencing medical findings across voluminous case files — multiple QME reports, treatment records, prior claim histories, deposition transcripts — is where the modern competitive advantage lives. The practitioner who can pull every reference to a specific body part's WPI across 600 pages of records in two minutes, instead of two hours, shows up to the MSC with facts. Everyone else shows up with impressions. If you're still doing that cross-referencing manually, Start Researching with a tool purpose-built for exactly this problem.
Under Ogilvie, a vocational rehabilitation expert's report can rebut the PDRS DFEC factor if it meets the substantial evidence threshold — meaning it must be individualized to the specific worker, grounded in actual labor market data, and explain why the schedule's presumptive adjustment does not accurately reflect this worker's diminished earning capacity. Generic vocational reports that simply assert diminished capacity without market analysis routinely fail on reconsideration.
Defense responses to vocational evidence focus on challenging methodology (sample bias, outdated market data, wrong occupational classification), attacking transferable skills analysis (ignoring the worker's demonstrated ability to perform alternative occupations), and presenting counter-vocational testimony. In C&R negotiations, the delta between a successfully rebutted PDRS and a defended one can be the difference between a six-figure settlement and a mid-five-figure one.
A contested PD case routinely involves hundreds of pages of QME and AME reports, DEU summaries, prior medical records, deposition transcripts, and treatment records spanning years. The volume isn't the only problem — the problem is finding the specific contradiction between what the QME said in the initial report and what they said in the supplemental, or the panel decision from 2024 where a WCJ applied Almaraz/Guzman on near-identical orthopedic facts and was affirmed on reconsideration.
Practitioners using AI-powered document analysis can surface conflicting WPI findings across reports in seconds. Vertical AI trained exclusively on WCAB case law eliminates the hallucination risk that makes general-purpose tools genuinely dangerous in a litigation context — citing a case that doesn't exist is worse than not citing any case at all, and that's a real risk with generic LLMs applied to specialized legal domains.
Speed is a strategic asset that compounds. The practitioner who arrives at the MSC with every relevant En Banc and panel decision already mapped to the facts — Almaraz/Guzman applications, apportionment attacks, Ogilvie rebuttals — from thousands of panel decisions without missing the one case that changes the outcome doesn't just perform better. They win more.
What is the permanent disability rating in California and how is it calculated? A PD rating is a percentage (0–100%) representing the degree of permanent impairment resulting from an industrial injury. It is calculated by converting the evaluating physician's WPI assessment through the PDRS using age, occupation, and date-of-injury modifiers under Labor Code §4660.1 for post-2005 injuries. [1]
How do indemnity rates translate to dollar values? Each percentage point of PD translates into a specific number of weeks of indemnity at a weekly rate tied to the injured worker's average weekly earnings, subject to statutory caps. At higher PD ratings (above 70%), the weekly rate and duration increase substantially, which is why a two-point swing at the high end of the scale produces disproportionately large dollar impacts. [5]
What is the 6-month rule for psyche claims under Labor Code §3208.3? Psychiatric injury claims filed within the first six months of employment face a heightened causation standard — actual events of employment must be the predominant (greater than 50%) cause of the psychiatric injury. This is one of the first threshold defenses defense counsel evaluates in any psychiatric add-on claim.
Can an injured worker who receives a 100% permanent and total disability rating still work? Yes. A 100% P&T rating entitles the worker to lifetime PD payments at the total disability rate, but it does not legally prohibit the worker from returning to work. If the worker earns wages above a certain threshold, payments may be subject to adjustment depending on the structure of the award.
How is PPD calculated and how does it differ from total permanent disability? Partial permanent disability (PPD) covers PD ratings below 100%, with indemnity paid for a defined number of weeks based on the rating percentage. Total permanent disability (100% PD) triggers lifetime payments. The calculation methodology is the same — the PDRS conversion of WPI — but the duration and rate of payment differ dramatically.
What happens procedurally when the WCAB denies the defense's reconsideration petition? The order denying reconsideration is the final WCAB determination. The next step is a Writ of Review to the California Court of Appeal under Labor Code §5950, which must be filed within 45 days. The Court of Appeal reviews the WCAB's legal conclusions de novo but defers to the WCAB's factual findings if supported by substantial evidence.
This is the tactical question practitioners should be asking before the evaluation, not after. Requesting a QME panel under Labor Code §4062.2 requires submitting the request to the Medical Unit, identifying the specialty, and engaging in the panel selection process under the one-time strike rules. The entire QME process from panel issuance to receipt of report commonly runs four to six months or longer in complex cases.
AME agreements are negotiated directly between counsel — no panel, no Medical Unit, no specialty limitation beyond what the parties agree. The cost split is typically 50/50, and the turnaround timeline is driven by the agreed evaluator's schedule rather than the DWC's administrative process. In high-value cases with complex multi-system injuries, the ability to select a mutually agreeable evaluator with specific expertise in the relevant specialty — and to jointly frame the questions — is worth the cost premium.
Real case outcomes consistently show that AME evaluations in complex orthopedic and neurological cases produce more nuanced, better-supported opinions that are harder to attack on reconsideration precisely because both parties had input into the framing. QME panels, by contrast, can produce favorable outcomes when the panel selection process yields an evaluator aligned with your specialty arguments — which is why the one-time strike decision is one of the most consequential tactical choices in the case.
Step one: Calendar the deadline immediately upon receipt of the adverse Order, Decision, or Award. Twenty days from service. No exceptions. No equitable tolling. [2]
Step two: Review the Opinion on Decision for specific legal errors — misapplication of the substantial evidence standard, failure to address Escobedo-compliant apportionment, incorrect application of Almaraz/Guzman, erroneous DEU rating adopted without analysis. Each error becomes a numbered assignment in your Petition.
Step three: Draft the Petition using WCAB Form 2 (Petition for Reconsideration). The Petition must identify specific assignments of error, cite supporting legal authority (En Banc decisions, Labor Code sections, Court of Appeal authority), and reference the specific record pages that support each argument.
Step four: File with the WCAB district office that issued the decision and serve all parties.
Step five: Monitor for the WCAB panel's ruling. Grant, deny, or rescind and return — each requires a different response strategy. If denied, evaluate writ of review to the Court of Appeal within the 45-day window under Labor Code §5950.
WCAB reconsideration petitions are denied at a high rate — estimates from DIR practice data suggest the majority of petitions do not result in reversal, which reinforces the importance of building your reconsideration record from the first deposition, not the last day before the deadline.
Permanent disability rating disputes at the WCAB are won or lost on the quality of your medical-legal foundation, the precision of your legal research, and your ability to move faster than opposing counsel through a procedural maze governed by Labor Code, the AMA Guides, and a constantly evolving body of En Banc and panel authority. Whether you're attacking an inflated WPI under Almaraz/Guzman, defending an apportionment opinion against an Escobedo challenge, or racing a 20-day reconsideration deadline under Labor Code §5903, the practitioners who consistently outperform are those who have already read every relevant case before the other side has found it.
Stop manually hunting through WCAB panel decisions when a PD dispute is heating up. CompFox is purpose-built for exactly this — search thousands of workers' comp cases with AI trained exclusively on California WC law, surface the apportionment, Ogilvie, and Almaraz/Guzman precedents that matter to your case, and get answers in seconds instead of hours. Start Researching today and show up to your next MSC with every case already loaded.
A permanent disability (PD) rating in California is a numerical percentage assigned to an injured worker that reflects the degree of lasting impairment caused by a work-related injury. Ratings range from 0% (no permanent disability) to 100% (total permanent disability). For injuries occurring on or after January 1, 2005, the rating is established using the AMA Guides 5th Edition to assess Whole Person Impairment (WPI), which is then converted into an adjusted PD rating through the Permanent Disability Rating Schedule (PDRS). The PDRS applies modifiers based on the worker's age, occupation, and date of injury to arrive at the final percentage. Even small differences in the rating — as little as two percentage points — can translate into tens of thousands of dollars in indemnity. Permanent disability rating disputes at the California WCAB are among the most technically contested issues in the workers' compensation system, often involving conflicting QME and AME reports, apportionment arguments under Labor Code §4663, and multiple body-part impairment assessments. Understanding how ratings are calculated is foundational to navigating any PD dispute effectively.
The payout for permanent impairment in California workers' compensation is determined by multiplying the PD rating percentage by a weekly indemnity rate and a set number of weeks tied to that percentage under the statutory schedule. As of 2026, maximum PD indemnity rates continue to climb, making high-percentage ratings especially significant in terms of financial exposure. For lower ratings (1%–14%), the weekly rate is lower, while ratings of 15% and above qualify for a higher weekly rate. Total permanent disability (100%) results in lifetime pension payments. The exact dollar amount depends on the worker's pre-injury wages (subject to statutory caps), the final adjusted PD percentage, and the applicable date-of-injury rate schedule. In complex multi-body-part cases, the cumulative exposure can easily reach six figures. Because even minor adjustments to the rating percentage can dramatically shift the payout, permanent disability rating disputes at the California WCAB frequently involve significant litigation over WPI assessments, apportionment, and the applicable rating schedule.
When the California WCAB denies a defense petition for reconsideration, the Workers' Compensation Judge's (WCJ) original decision becomes final and binding at the WCAB level. At that point, the defense has the option to seek further appellate review by filing a Petition for Writ of Review in the California Court of Appeal. This must typically be done within 45 days of the WCAB's denial order. The Court of Appeal reviews WCAB decisions under a substantial evidence standard, meaning it will uphold the Board's findings if they are supported by credible evidence in the record, even if other interpretations were possible. This standard makes reversals difficult unless there was a clear legal error or an absence of supporting evidence. For practitioners handling permanent disability rating disputes at the California WCAB, a denied reconsideration petition signals that building a strong medical-legal record before the hearing — through well-developed QME or AME reports and thorough cross-examination — is far more effective than relying on post-decision appeals to correct evidentiary shortcomings.
The 6-month rule for psychiatric injuries in California workers' compensation is found in Labor Code §3208.3(d), which requires that an employee must have been employed by the employer for at least six months before a psychiatric injury claim is compensable. This employment duration threshold is a threshold compensability requirement, not just a rating issue. There is an exception for sudden and extraordinary employment conditions, where the 6-month minimum does not apply if the psychiatric injury was caused by a sudden and extraordinary event. Additionally, under Labor Code §4660.1(c), for physical injuries occurring on or after January 1, 2013, psychiatric impairment that arises secondary to a compensable physical injury is generally not ratable as an additional WPI component, unless the injury falls into specific exceptions such as violent acts or catastrophic injuries. This distinction is critically important in permanent disability rating disputes at the California WCAB, as it can bar or significantly limit psychiatric add-on ratings that otherwise might substantially increase the overall PD percentage and indemnity exposure.
In California workers' compensation, a 100% permanent and total (P&T) disability rating means the injured worker has been assessed as having a total loss of earning capacity due to their industrial injuries. However, this does not automatically create a legal prohibition on working. A worker rated at 100% P&T is entitled to lifetime weekly indemnity payments, but if they return to work and earn wages, those earnings can potentially affect their ongoing entitlement to total disability payments depending on the circumstances. In practice, returning to substantial gainful employment while receiving 100% P&T benefits can expose the worker to allegations of fraud or result in a petition to reopen or modify the award based on changed circumstances. It is also worth noting that a 100% rating under California's PDRS is distinct from federal VA disability ratings or Social Security disability determinations. For any injured worker navigating a 100% PD rating, consulting with a workers' compensation attorney is essential to understanding how earnings from employment may interact with their permanent disability award and avoid potential legal complications.
Permanent partial disability (PPD) in California is calculated through a multi-step process governed by the AMA Guides 5th Edition and the Permanent Disability Rating Schedule (PDRS). First, a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) assesses the injured worker's Whole Person Impairment (WPI) using clinical findings and the AMA Guides. For injuries on or after January 1, 2005, §4660.1 mandates this approach. Next, the raw WPI percentage is entered into the PDRS, which applies occupation and age modifiers tied to the date of injury to produce an adjusted PD rating percentage. If apportionment applies under Labor Code §4663 — attributing a portion of the disability to non-industrial factors such as prior conditions or degenerative changes — the non-industrial percentage is subtracted, reducing the compensable rating. Once the final adjusted PD percentage is established, it is matched against the statutory indemnity schedule to determine the number of compensable weeks and the applicable weekly rate, based on the worker's pre-injury average weekly wage subject to statutory caps. Permanent disability rating disputes at the California WCAB most commonly arise from disagreements over WPI assessments, apportionment percentages, and the proper application of PDRS modifiers — all of which can significantly shift the final dollar value of the award.
[1] https://www.dir.ca.gov/dwc/permanentdisability.htm. dir.ca.gov. https://www.dir.ca.gov/dwc/permanentdisability.htm
[2] https://www.dir.ca.gov/wcab/wcab_enbanc.htm. dir.ca.gov. https://www.dir.ca.gov/wcab/wcab_enbanc.htm
[3] https://www.lagunalawfirm.com/california-workers-compensation-how-to-handle-a-dispute-over-your-disability-rating/. lagunalawfirm.com. https://www.lagunalawfirm.com/california-workers-compensation-how-to-handle-a-dispute-over-your-disability-rating/
[4] https://www.rjylaw.com/wcab-upholds-opinion-that-limited-an-injured-workers-permanent-disability-benefits-due-to-pre-existing-injury/. rjylaw.com. https://www.rjylaw.com/wcab-upholds-opinion-that-limited-an-injured-workers-permanent-disability-benefits-due-to-pre-existing-injury/
[5] https://yazdchilaw.com/banning-ca-permanent-disability-workers-comp-lawyer/. yazdchilaw.com. https://yazdchilaw.com/banning-ca-permanent-disability-workers-comp-lawyer/
The landscape of apportionment in California workers' compensation law is undergoing a subtle but significant transformation.

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