WCPanelIQ
PanelQMEMed-legalGranted

Aguirre, Josimar

JOSIMAR AGUIRRE, Applicant vs. PAPA CANTELLAS; SENTRY INSURANCE COMPANY, Defendants

ADJ number
ADJ11757093
Decision date
May 1, 2024
District office
Van Nuys
WCJ
—
Claim administrator
Sentry Insurance Company
Commissioners
CRAIG SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, LISA A. SUSSMAN, DEPUTY COMMISSIONER

Injury / body parts: lower back, lumbar spine, right index finger

LC §3202.5LC §3600LC §4060LC §4061LC §4062.3LC §5402LC §5505LC §5701LC §5906LC §5952CCR §10465

Summary

Applicant Josimar Aguirre claimed an industrial low back injury occurring November 10, 2018, in addition to an accepted right index finger injury. The PQME, Dr. Jerrold Sherman, issued multiple reports and a deposition that contained contradictory and speculative opinions—initially finding industrial causation, then reversing to non-industrial after learning applicant gave inconsistent histories about the mechanism of injury. The WCJ found no industrial injury to the low back based on Dr. Sherman's reporting and applicant's non-credible testimony. The Board granted reconsideration, holding that Dr. Sherman's opinion did not constitute substantial medical evidence because it was speculative, inconsistent, and inadequately reasoned, and that applicant's credibility alone, absent substantial medical evidence on injury, could not support the decision. The Board rescinded the Findings and Order and remanded for further development of the record with a new evaluator.

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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