WCPanelIQ
PanelQMEMed-legalGranted

Ortega, Jose

JOSE ORTEGA, Applicant vs. CARDENAS MARKETS, LLC; SAFETY NATIONAL CASUALTY CORPORATION, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ13713694
Decision date
May 8, 2025
District office
San Diego
WCJ
—
Claim administrator
Sedgwick Claims Management Services (administering for Safety National Casualty Corporation)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: respiratory system, lungs, left eye, left leg, COVID-19 infection

LC §3212LC §3213LC §3212.86LC §3212.87LC §3212.88LC §3202.5LC §5705LC §3600LC §5701LC §5906LC §5909LC §5900LC §5950LC §5907LC §5908LC §5908.5LC §5803LC §5901

Summary

Applicant Jose Ortega, a meat assistant manager for Cardenas Markets, tested positive for COVID-19 on May 10, 2020, after which he fell into a coma (May 21–June 25, 2020) and developed complications including blood clots and left eye vision loss. The WCJ found applicant sustained an industrial COVID-19 injury under the Labor Code section 3212.86 presumption and that defendant failed to rebut it. Defendant sought reconsideration, arguing the section 3212.86 presumption was repealed effective January 1, 2024 (before the February 3, 2025 F&O), that QME Dr. Gupta's reports were not substantial medical evidence, and that the WCJ's request for supplemental QME reporting constituted judicial bias. The Appeals Board granted reconsideration to allow further study of the factual and legal issues, particularly whether the section 3212.86 presumption applies given the repeal, and deferred a final decision on the merits.

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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