WCPanelIQ
PanelQMEMed-legalDenied

Valdez, Isabel

ISABEL VALDEZ, Applicant vs. ROSS STORES, INC.; ARCH INSURANCE COMPANY, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ10892681
Decision date
Oct 20, 2024
District office
San Diego
WCJ
—
Claim administrator
Sedgwick Claims Management Services (administering for Arch Insurance Company)
Commissioners
CRAIG SNELLINGS, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: lower back, left knee, left leg

LC §4062.3LC §5813LC §5814LC §5814.5LC §3202.5LC §4600LC §4604.5LC §4610.5LC §5900LC §5909CCR §10421CCR §10600

Summary

Isabel Valdez sustained an industrial injury to her lower back and left knee while working as a retail associate for Ross Stores on January 17, 2016. After a first trial in 2018, the WCJ relied on a stipulation that the back was industrial, but a subsequent open-air MRI prompted the PQME to conclude the back condition was non-industrial, and the WCJ later granted defendant's petition to set aside the stipulation. Both parties sought reconsideration of the July 17, 2024 F&O: defendant sought sanctions for an alleged ex parte communication and alleged misrepresentations in applicant's penalty petition, while applicant sought 5814 penalties, 5814.5 attorney fees, and 5813 sanctions for alleged failure to provide medical treatment and bad-faith disregard of the stipulation. The Appeals Board denied both Petitions, finding no ex parte communication occurred (the July 30, 2019 letter was a properly served subsequent communication under section 4062.3(e)), no misrepresentations supporting sanctions, and no evidence that applicant established entitlement to the medical treatment she claimed was denied (no RFA was ever placed into evidence).

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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