WCPanelIQ
PanelQMEMed-legalDenied

Valencia, Jose

JOSE VALENCIA, Applicant vs. CITY OF DALY CITY; INNOVATIVE CLAIM SOLUTIONS SAN RAMON, Defendants

ADJ number
ADJ14902030
Decision date
Jan 23, 2025
District office
San Francisco
WCJ
—
Claim administrator
Innovative Claim Solutions San Ramon (third-party administrator for self-insured City of Daly City)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: respiratory system, circulatory system/heart

LC §5412LC §5909LC §5900LC §3212LC §4663LC §3600LC §3202.5LC §3208.1LC §3208.2LC §5303LC §4664LC §5813LC §5705LC §5952LC §3208CCR §10517CCR §10421

Summary

Jose Valencia, a firefighter for the City of Daly City from 2004-2021, claimed cumulative injury to his respiratory system (occupational asthma) and circulatory/heart system. The WCJ found a single cumulative injury (ADJ14902030) causing 79% permanent disability with a life pension and awarded benefits, while ordering applicant take nothing in the duplicative second claim (ADJ19260558). Defendant sought reconsideration arguing there should be two separate cumulative trauma periods with different section 5412 dates of injury, and that it met its apportionment burden. The Board denied reconsideration, holding that the number of injuries is determined by causation analysis, not by when disability for different body parts manifests, and that a single period of injurious exposure ending on applicant's last day of work (January 23, 2021) produced one cumulative injury. The Board further held the QME's apportionment opinion (regarding seasonal allergies and prior firefighting employment) was not substantial evidence and that heart presumption cases under section 3212 are not subject to apportionment per section 4663(e).

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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