WCPanelIQ
PanelQMEMed-legalRemanded

Ochoa, Maria

MARIA OCHOA, Applicant vs. FXI, INC.; ACE AMERICAN INS. CO., administered by ESIS, Defendants

ADJ number
ADJ12878263
Decision date
Dec 22, 2024
District office
San Francisco
WCJ
—
Claim administrator
ESIS (administering for ACE American Ins. Co.)
Commissioners
ANNE SCHMITZ, DEPUTY COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: shoulders, upper extremities, neck

LC §5705LC §3202.5LC §3600LC §3600(a)

Summary

Maria Ochoa claimed an industrial injury to her shoulders, upper extremities, and neck while moving heavy mattress foam on October 10, 2019. The WCJ found applicant failed to prove industrial causation, ruling her injury history was not credible because she first reported the injury after being disciplined for hitting a coworker with cardboard. On reconsideration, the Board found no Garza issue existed because the WCJ did not actually reject applicant's testimony based on her demeanor and in fact found nothing inherently unlikely about her account. The Board also found the QME's reporting was not substantial medical evidence because no party provided the QME with applicant's medical records, leaving her AOE/COE opinion based on an inadequate history. The Board rescinded the F&O and remanded for further proceedings.

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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