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PanelQMEMed-legalGranted

Garcia, Andres De Jesus

ANDRES DE JESUS GARCIA, Applicant vs. SLATER’S 50/50; SECURITY NATIONAL INSURANCE COMPANY administered by AMTRUST NORTH AMERICA, Defendants

ADJ number: ADJ19947925
Decision date: May 18, 2025
District office: Pomona
WCJ: —
Claim administrator: AmTrust North America (administering for Security National Insurance Company)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, PAUL F. KELLY, COMMISSIONER

Injury / body parts: right eye

LC §5909LC §5900LC §4616.3LC §4616.4LC §4600LC §4616LC §4061LC §4062LC §4060LC §5950LC §5907LC §5908LC §5908.5LC §5803LC §5901LC §4600.3CCR §9767.6CCR §9767.7CCR §10600CCR §9785

Summary

Applicant Andres De Jesus Garcia, a dishwasher who claimed an August 10, 2015 industrial injury to his right eye, sought reconsideration of a March 12, 2025 F&A that denied him a new PTP or second opinion within the MPN. Both the original PTP (Dr. Innocenzi, October 15, 2015) and the PQME (Dr. Vishteh, July 20, 2023) found applicant reached MMI with no need for future medical care. Applicant argued he is entitled to either a change of PTP or a second opinion within the MPN under WCAB Rules 9767.6(e) and 9767.7 and Labor Code sections 4616.3 and 4616.4, and contended that the Rushing precedent is no longer valid. The Board granted reconsideration to allow further study of the factual and legal issues, finding it unclear which statutory framework applies, and deferred a final decision on the merits. The grant was timely under the amended section 5909 because the case was transmitted and the Report served on March 18, 2025.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.