WCPanelIQ
PanelQMEMed-legalGranted in Part

Lira, Jeanette

JEANETTE LIRA, Applicant vs. COTTAGE HEALTH SYSTEM, PSI, administered by GALLAGHER BASSETT; SANSUM SANTA BARBARA MEDICAL; ZURICH AMERICAN INSURANCE COMPANY, Defendants

ADJ number
ADJ9198656
Decision date
Jan 5, 2025
District office
Santa Barbara
WCJ
—
Claim administrator
Gallagher Bassett (administering Cottage Health System, PSI); Zurich North American Insurance Company (for Sansum Santa Barbara Medical)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: bilateral upper extremities, neck, gastrointestinal system, skin, Complex Regional Pain Syndrome (CRPS)

LC §5500.5LC §5412LC §5909LC §5900LC §4664LC §4656LC §4658CCR §10600CCR §10517

Summary

Applicant Jeanette Lira, a phlebotomist, pleaded two separate cumulative trauma injuries—one during employment with Sansum Santa Barbara Medical (March 19, 2001 to July 17, 2006, insured by Zurich) and one with Cottage Health System (August 1, 2009 to January 3, 2011, self-insured). The PWCJ found that applicant sustained one continuous trauma and awarded 100 percent permanent total disability without apportionment in each case. Both defendants sought reconsideration, with Zurich arguing the record supports a single cumulative injury (and that dual 100% awards exceed section 4664(c)(2) limits) and Cottage Health arguing the two periods were distinct injuries and that AWW was based on speculative testimony. The Board agreed with the PWCJ that applicant sustained one cumulative injury (relying on AME Dr. Hasday's repeated opinion of a single overarching CT and the continued medical treatment between periods per Austin), but rescinded the F&A because the findings improperly reflected two separate injuries each with 100% disability. The Board substituted joint findings reflecting a single cumulative injury from March 19, 2001 through January 3, 2011 and returned the matter to the trial level to determine the section 5500.5 liability period and the section 5412 date of injury.

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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