WCPanelIQ
PanelQMEMed-legalDenied

Bustamante, Enrique

ENRIQUE BUSTAMANTE, Applicant vs. SCRIPPS HEALTH, self-insured, administered by SEDGWICK RIVERSIDE, Defendants

ADJ number
ADJ14292521
Decision date
May 19, 2024
District office
San Diego
WCJ
Douglas E. Webster
Claim administrator
Sedgwick Riverside (administering for Scripps Health, self-insured)
Commissioners
—

Injury / body parts: low back, lumbar spine

LC §5502LC §5952CCR §31.5

Summary

Applicant Enrique Bustamante, a Sterile Processing Technician for self-insured Scripps Health, claimed a cumulative trauma injury to his low back through May 23, 2020. The WCJ initially vacated submission to develop the record because the PQME, Dr. Steven Wachs, lacked adequate history of applicant's prior 2003 industrial injury; after supplemental reporting, the WCJ found AOE/COE to the low back and a need for further medical treatment. Defendant petitioned for reconsideration arguing Dr. Wachs should be removed as PQME and that his reporting was not substantial medical evidence. The WCAB adopted and incorporated the WCJ's Report, holding that the removal issue was improperly raised for the first time on reconsideration and that Dr. Wachs' August 17, 2023 report constituted substantial medical evidence. Reconsideration was denied.

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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