WCPanelIQ
PanelQMEMed-legalGranted

Chen, Christopher

CHRISTOPHER CHEN, Applicant vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND, Defendants

ADJ number
ADJ15446830
Decision date
Aug 15, 2024
District office
San Jose
WCJ
Norma L. Acosta
Claim administrator
Subsequent Injuries Benefits Trust Fund
Commissioners
—

Injury / body parts: cervical spine, lumbar spine, bilateral upper extremities, bilateral lower extremities, left shoulder, bilateral carpal tunnel syndrome

LC §4751LC §4600CCR §41.5CCR §41.6CCR §10940CCR §60CCR §40CCR §41CCR §61CCR §65

Summary

Applicant Christopher Chen, a chiropractor and longtime QME, sought SIBTF benefits on a cumulative trauma claim, relying on medical reports from Dr. Donald Lee (his predesignated treating physician), Dr. Demeil Betoushana (his SIBTF QME), and Dr. Benjamin/Mark Greer (who performed EMG testing). The WCJ found these reports were not substantial evidence due to extensive conflicts of interest under 8 CCR 41.5—including shared QME office locations, longtime friendships, applicant serving as the treating physician for his own QME, and a former attorney who represented both applicant and Dr. Betoushana—and found applicant failed to meet the Labor Code 4751 threshold. The Appeals Board agreed conflicts of interest existed under 8 CCR 41.5 but held the proper remedy under 8 CCR 41.6 is to obtain new medical evaluators, not to deny benefits outright. The Board granted reconsideration, amended the findings to defer the issue of SIBTF entitlement, and returned the matter to the trial level, encouraging the parties to seek Agreed Medical Evaluators without conflicts.

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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