WCPanelIQ
PanelQMEMed-legalDenied

Flores, Andre

ANDRE FLORES, Applicant vs. CALIFORNIA DEPARTMENT OF TRANSPORTATION, LEGALLY UNINSURED; STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES, Defendants

ADJ number
ADJ15347791
Decision date
Mar 27, 2024
District office
Santa Barbara
WCJ
—
Claim administrator
State Compensation Insurance Fund (for legally uninsured California Department of Transportation)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: thoracic spine, lumbar spine, cervical spine, right ankle, right elbow

LC §5903LC §4663CCR §10605

Summary

Andre Flores, an Equipment Operator II for Caltrans, sustained an admitted industrial injury on April 16, 2020 to multiple body parts. The WCJ found applicant permanently and totally disabled without apportionment, relying on vocational expert P. Steve Ramirez and supportive QME opinions. Defendant sought reconsideration, arguing the QME's 10% apportionment was valid, that the QME lacked vocational expertise, and that applicant's vocational expert applied an incorrect legal standard. The Board first found the Petition timely because service was not actually accomplished until applicant's counsel served the F&A on January 11, 2024. On the merits, the Board affirmed, holding the QME's apportionment opinion was not substantial medical evidence because it failed to explain how or why the preexisting condition caused 10% of permanent disability and was not stated to a reasonable medical probability ('I think there's a 90 percent chance'). Because no valid medical apportionment was identified, applicant was entitled to an unapportioned award.

Issues

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Holding

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Analysis

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Defense takeaway

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