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PanelQMEMed-legalDenied

Smith, Maranda

MARANDA SMITH, Applicant vs. CENTENE CORPORATION, AMERICAN ZURICH INSURANCE COMPANY, administered by GALLAGHER BASSETT SERVICES, INC., Defendants

ADJ number: ADJ15495990
Decision date: Jun 23, 2024
District office: Sacramento
WCJ: Peter M. Wilkens
Claim administrator: Gallagher Bassett Services, Inc. (administering American Zurich Insurance Company)
Commissioners: —

Injury / body parts: head (headaches), back, neck (cervical spine)

LC §3600LC §5900LC §5902LC §5903

Summary

Applicant Maranda Smith sought reconsideration of an April 4, 2024 Findings and Order in which the WCJ found she did not sustain a cumulative trauma injury AOE/COE to her head (headaches), back, or neck through April 23, 2021, and ordered her to take nothing. Applicant challenged the opinion of orthopedic AME James B. Stark, M.D. as not substantial medical evidence, alleged bias, and requested a new orthopedic evaluation. The WCAB denied reconsideration, adopting the WCJ's Report, finding that Dr. Stark's reports (along with the neurology AME report of Pramila R. Gupta, M.D.) were well-reasoned, based on adequate history, examination, and review of records, and thus constituted substantial medical evidence. The Board noted that AME opinions are presumptively followed because the AME is chosen by the parties for expertise and neutrality, and applicant offered no credible evidence of bias.

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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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.