WCPanelIQ
PanelQMEMed-legalLienRemanded

Robinson, Kerri

KERRI ROBINSON, Applicant vs. FRANK D. LANTERMAN DEVELOPMENTAL SERVICES; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ4391030
Decision date
Date unavailable
District office
Pomona
WCJ
—
Claim administrator
State Compensation Insurance Fund
Commissioners
CRAIG SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER

Injury / body parts: neck, back, psyche, dental, TMJ, teeth, face, headaches, salivary changes/xerostomia, bruxism, knees, shoulders

LC §112LC §115LC §5301LC §5901LC §5908.5LC §5950LC §5906LC §5908LC §5315LC §5701LC §5911LC §5951LC §5909LC §4709LC §5908.5LC §5952LC §5953LC §4600LC §4616LC §5903LC §4709CCR §10320CCR §10330CCR §10961CCR §10962CCR §10995CCR §10205CCR §10205.4

Summary

Lien claimant Dental Trauma Center (Dr. Mayer Schames) sought reconsideration of a WCJ's Findings and Order that found dental treatment before the defense QME's October 11, 2005 evaluation was reasonable and necessary, but that treatment after that date was attributable to applicant's 1987 non-industrial gunshot injury rather than her 2004 industrial injuries. The WCAB held that the WCJ erred by effectively apportioning medical treatment, since under Granado medical treatment is not apportionable and the employer must pay all reasonable treatment if industrial injury contributed to the need for it. The Board found Dr. Peterson's QME opinion regarding future treatment was not substantial evidence because it rested on an incorrect legal theory of apportionment and an inadequate medical history (no re-examination after October 2005). The Board affirmed the F&O but amended it to defer the issue of whether post-October 11, 2005 treatment was reasonable and necessary, and remanded to the WCJ 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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