WCPanelIQ
PanelQMEMed-legalDenied

Miller, James

JAMES EVERETT MILLER, Applicant vs. BAYSIDE PATROL & INVESTIGATIONS, INC., EVEREST NATIONAL INSURANCE COMPANY, Defendants

ADJ number
ADJ10870144
Decision date
Oct 8, 2024
District office
San Jose
WCJ
—
Claim administrator
Everest National Insurance Company
Commissioners
CRAIG SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: lumbar spine, left foot

LC §5811LC §5708LC §5709LC §5900LC §5909CCR §10600

Summary

Applicant James Miller, a security guard, claimed industrial injury to his lumbar spine and left foot. QME Dr. Soozani declared him permanent and stationary and a Qualified Injured Worker (QIW). After significant deterioration of his lumbar condition requiring a surgery consult and MRI, applicant's counsel retained vocational expert Scott Simon, who issued a report finding applicant not feasible for retraining with an 80% loss of future earnings capacity. The WCJ awarded $7,375 in section 5811 costs for the vocational reporting, and defendant sought reconsideration, arguing the report was not reasonable or necessary because no vocational dispute existed when it was procured. The Appeals Board denied reconsideration, holding the vocational evaluation was reasonable and necessary at the time it was incurred under Costa, given applicant's QIW status, documented worsening medical condition, and the report's potential to affect the permanent disability rating.

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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