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PanelQMEMed-legalGranted

Anaya, Jose

JOSE ANAYA, Applicant vs. SCOTIA TOOL & MACHINE, INC.; PROCENTURY INSURANCE COMPANY, adjusted by ILLINOIS MIDWEST, Defendants

ADJ number: ADJ10361114
Decision date: Dec 30, 2024
District office: Oakland
WCJ: —
Claim administrator: Illinois Midwest Insurance Agency (for ProCentury Insurance Company)
Commissioners: JOSÉ H. RAZO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: left arm, left wrist, left elbow, left hand, left shoulder, psyche, low back, trunk, legs

LC §5909LC §5900LC §4660LC §4660.1LC §4662LC §4663LC §4664LC §4751CCR §10759

Summary

Applicant Jose Anaya, a machinist, sustained serious industrial injuries to his left upper extremity and psyche on February 22, 2016, when his shirt sleeve caught in a lathe. The WCJ found him 100% permanently totally disabled based on CVC rebuttal and vocational evidence. Defendant sought reconsideration, arguing neither the medical evidence supporting CVC rebuttal nor the competing vocational reporting constituted substantial evidence. The Appeals Board granted reconsideration, finding that the orthopedic QME's CVC rebuttal opinion was not substantial medical evidence (no ADL analysis), applicant's vocational expert improperly inserted medical opinions, and defendant's vocational expert improperly relied on non-industrial factors (English language ability and an erroneous assumption that the back injury was non-industrial). The Board rescinded the F&A, deferred the permanent disability issue, and returned the matter for further development of the record.

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.