WCPanelIQ
PanelQMEMed-legalGranted

Maldonado, Jose

JOSE MALDONADO, Applicant vs. WASTE MANAGEMENT INC; ACE AMERICAN INSURANCE COMPANY; GALLAGHER BASSETT SERVICES INC., Defendants

ADJ number
ADJ11919641
Decision date
Apr 7, 2024
District office
San Diego
WCJ
—
Claim administrator
Gallagher Bassett Services Inc. (TPA); ACE American Insurance Company
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: head, psyche, hearing, dental, closed head brain injury, MTBI, stroke, eyes, vision, sleep apnea (alleged)

LC §5903LC §5952LC §4060LC §4061LC §4062.3LC §5705LC §5313LC §5907LC §5908LC §5908.5LC §5803LC §5901LC §5950CCR §10964CCR §10787

Summary

Jose Maldonado, a commercial truck driver, sustained an admitted industrial injury on July 12, 2018 when he slipped and fell hitting his head on a metal dumpster, and later suffered an ischemic stroke in December 2019. The WCJ found 67% permanent disability after apportionment, rejected applicant's claim of 100% PD, found no industrial sleep apnea injury, and found applicant failed to rebut the permanent disability rating schedule. Applicant sought reconsideration arguing he is 100% permanently disabled, that the GAF score of 55 for sleep apnea was valid, and that PQME Dr. Sara Siavoshi's apportionment opinion was not substantial medical evidence. The Appeals Board granted reconsideration as a procedural matter and deferred a final decision, noting it was unclear whether legal issues were properly identified and whether the record was sufficiently developed—particularly observing that Dr. Alvarez's QME report indicated the sleep study should be addressed by a specialist, which apparently did not occur. The Board ordered further review of the merits and encouraged the parties to use the voluntary mediation program.

Issues

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Holding

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Analysis

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Defense takeaway

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