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PanelQMEMed-legalDenied

Garcia, Octavio

OCTAVIO GARCIA, Applicant vs. FANTASY ACTIVE WEAR, INC.; STARNET INSURANCE COMPANY, administered by, BERKLEYNET, Defendants

ADJ number: ADJ13584402
Decision date: Mar 25, 2024
District office: Los Angeles
WCJ: —
Claim administrator: BerkleyNet (administering for Starnet Insurance Company)
Commissioners: CRAIG SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: left shoulder, left elbow, left arm, bilateral arms, bilateral hands, fingers, back, bilateral shoulders, waist, bilateral upper extremities

LC §5904LC §3201CCR §30CCR §10955

Summary

Applicant Octavio Garcia sustained a specific injury (10/28/2019) and a cumulative injury (ending 3/19/2020), both of which defendant denied via separate denial letters served on December 2, 2020. Defendant then timely requested an orthopedic surgery QME panel (#7380673) on December 18, 2020, but did not re-serve a copy of its denial letter when serving the panel request. Applicant later requested a chiropractic panel on December 28, 2020, and argued defendant's earlier panel was invalid because defendant failed to attach supporting documentation under Rule 30(b)(1)(C). The WCJ found the orthopedic panel valid and proper, rejecting applicant's later chiropractic panel. The Appeals Board, applying the removal standard because applicant only challenged an interlocutory finding, affirmed the April 22, 2021 F&O, finding no significant prejudice or irreparable harm.

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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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.