WCPanelIQ
PanelQMEMed-legalGranted in Part

Medina, Jose

JOSE MEDINA, Applicant vs. FOSTER DAIRY FARMS, PERMISSIBLY SELF-INSURED, ADMINISTERED BY GALLAGHER BASSETT SERVICES, Defendants

ADJ number
ADJ17875984
Decision date
Nov 6, 2024
District office
Lodi
WCJ
—
Claim administrator
Gallagher Bassett Services
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: right wrist

LC §5909LC §5900LC §5705LC §4060LC §4061LC §4062LC §4600.5LC §4616.3LC §4616.4CCR §10600CCR §9785CCR §10682

Summary

Applicant Jose Medina, a dairy worker, sustained an industrial right wrist injury on August 10, 2022. His primary treating physician at Concentra declared him permanent and stationary and released him to full duty without restrictions in October and December 2022. Applicant later obtained a panel QME (Dr. Agubuzu) who, after reviewing records, found applicant not yet P&S and capable of modified work with no use of the right upper extremity. The WCJ denied TTD from October 19, 2023 through April 15, 2024, finding the QME reporting was not substantial evidence and applicant's testimony not credible due to lack of contemporaneous treatment records. The Board granted reconsideration, holding that applicant was precluded from obtaining a new PTP until he obtained a QME (per Rule 9785 and Rushing), so the lack of interim records was justified; once the QME established work restrictions, the burden shifted to defendant to show modified work was offered, which it failed to do. The Board awarded 45 days of TTD commencing December 21, 2023, limited because no PTP reporting existed for the full claimed period.

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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