WCPanelIQ
PanelQMEMed-legalDenied

Bettencourt, Jeffrey

JEFFREY BETTENCOURT, Applicant vs. AMAZON, AMERICAN ZURICH INSURANCE, administered by SEDGWICK CMS, Defendants

ADJ number
ADJ13163916
Decision date
Dec 18, 2024
District office
Lodi
WCJ
Timothy Nelson
Claim administrator
Sedgwick CMS (administering for American Zurich Insurance)
Commissioners
—

Injury / body parts: right knee, right ankle/Achilles

LC §5909LC §5900LC §4663LC §4664CCR §10600CCR §10962

Summary

Applicant Jeffrey Bettencourt sought reconsideration of an amended Findings of Fact, Award, and Orders that found defendant entitled to 60% apportionment of his right knee permanent disability to nonindustrial factors. Applicant argued the QME, Dr. Jeryl Wiens, failed to explain the 'how and why' of his apportionment percentages and provided no preexisting impairment ratings, that the apportionment was unreasonable, and that Hikida barred apportionment because the disability arose from medical treatment (total knee replacement). The WCAB panel adopted the WCJ's Report and denied reconsideration, concluding the case aligned with County of Santa Clara v. WCAB (Justice) rather than Hikida because the total knee replacement was not an unsuccessful treatment producing a new injury but rather the basis of impairment caused by both industrial and significant nonindustrial degenerative factors. The panel found Dr. Wiens's reports and testimony constituted substantial evidence supporting the 60% nonindustrial apportionment given applicant's extensive history of prior knee surgeries and active lifestyle. The panel also addressed the timeliness of its decision under amended Labor Code section 5909, finding it acted within 60 days of transmission.

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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