WCPanelIQ
PanelQMEMed-legalGranted in Part

Pelico Ajtun, Estela

ESTELA PELICO AJTUN, Applicant vs. PARTNERS PERSONNEL MANAGEMENT SERVICES; STARR SPECIALITY INSURANCE COMPANY, Defendants

ADJ number
ADJ15289923
Decision date
Dec 12, 2024
District office
Anaheim
WCJ
—
Claim administrator
Starr Specialty Insurance Company
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, PAUL F. KELLY, COMMISSIONER

Injury / body parts: lumbar spine, thoracic spine, cervical spine, left side of scalp, right upper extremity, left upper extremity, visual system, nervous system

LC §5909LC §5900LC §4061LC §5502CCR §10744

Summary

Applicant suffered a specific injury on July 24, 2021 when she fell and hit her head while working as a laborer. The defendant accepted injury to the lumbar, thoracic, cervical spine, and left scalp but disputed injury to the upper extremities, nervous system, and visual system. The orthopedic PQME (Dr. Mauro) repeatedly recommended neurological and ophthalmological PQME evaluations, but the parties never obtained them; instead defendant arranged consulting examinations that did not address causation. The WCJ found no AOE/COE to the disputed parts and concluded applicant waived her objection to proceeding by failing to object to a facially defective DOR. The Board granted applicant's petition, finding extraordinary circumstances excused the failure to object, rescinded the F&A, ordered further development of the record on the neurological and ophthalmological complaints, deferred all other issues, and dismissed defendant's TD overpayment petition as moot.

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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