WCPanelIQ
PanelQMEDenied

Ortiz, Marta

MARTA ORTIZ, Applicant vs. BLACK OAKS, INC.; TECHNOLOGY INSURANCE, Defendants

ADJ number
ADJ10822061
Decision date
Jul 28, 2024
District office
Santa Barbara
WCJ
—
Claim administrator
Technology Insurance
Commissioners
—

Injury / body parts: right knee, left knee, bilateral knees

Summary

Marta Ortiz, a 57-year-old housekeeper, sustained an admitted specific injury to her right knee on April 3, 2016, with a compensable consequence injury to her left knee admitted at trial. The WCJ awarded 86% permanent disability without apportionment, using a Kite analysis to add the bilateral knee impairments rather than combining them. Defendant sought reconsideration arguing the WCJ should have applied PQME Dr. Scott Graham's 50% apportionment to non-industrial degenerative osteoarthritis. The WCAB denied reconsideration, finding Dr. Graham's apportionment opinion did not constitute substantial medical evidence because he failed to identify the underlying epidemiological studies or explain how and why the degenerative condition caused or contributed to applicant's permanent disability. The Board also rejected the doctor's flawed assumption that compensable consequence injuries must be apportioned identically to the index injury.

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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