WCPanelIQ
PanelQMEMed-legalGranted in Part

Esp, Wayne

WAYNE ESP, Applicant vs. CAMBRON ROOFING AND WATERPROOFING, INC.; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ11179850
Decision date
Apr 22, 2024
District office
Santa Barbara
WCJ
—
Claim administrator
State Compensation Insurance Fund
Commissioners
—

Injury / body parts: back, chest, lung, respiratory system, right shoulder, head, right scapula, right hand, right finger, clavicle, psyche

LC §3600LC §4053LC §5701LC §5705LC §3202.5LC §5906CCR §31.7CCR §10843

Summary

Applicant Wayne Esp, a roofer, fell about 10 feet while holding a 300-pound skylight on September 28, 2017, sustaining multiple injuries. Defendant denied the claim asserting the intoxication defense under Labor Code section 3600(a)(4), relying on a blood alcohol level of 172 mg% (more than twice the legal limit). The WCAB affirmed the WCJ's finding that the claim was not barred by intoxication, holding that while defendant established intoxication, it failed to prove that intoxication was a proximate or substantial cause of the fall, because the QME's causation opinion was not substantial evidence (it was rendered without readily available information about the worksite and coworker statements). The Board also held the WCJ improperly appointed a regular physician under section 5701 to supplant the proper process for obtaining an additional panel QME. The Board rescinded the F&O, issued amended findings that the claim is not barred by sections 3600(a)(4) or 4053, deferred all other issues, and returned the matter for further development of the record.

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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