WCPanelIQ
PanelQMEMed-legalGranted

Ross, James

JAMES ROSS, Applicant vs. CITY OF SCOTTS VALLEY; ACCLAMATION INSURANCE MANAGEMENT SERVICES, Defendants

ADJ number
ADJ12707737
Decision date
Feb 25, 2024
District office
Salinas
WCJ
—
Claim administrator
Acclamation Insurance Management Services
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: lumbar spine, cervical spine, bilateral shoulders, bilateral carpal tunnel syndrome, bilateral epicondylitis, hearing loss, hypertensive cardiac disease

LC §3202.5LC §4600LC §4628LC §4650LC §5404LC §5405LC §5412LC §5705LC §5904

Summary

Applicant James Ross, a Worker II for the City of Scotts Valley for approximately ten years (2003-2013), filed a cumulative trauma claim on November 4, 2019, alleging injuries to multiple body parts. The WCJ found the claim was not barred by the statute of limitations because under Labor Code section 5412, applicant did not know and could not reasonably have known his disabilities were industrially caused until evaluated by the PQMEs. Defendant sought reconsideration, arguing the claim was time-barred, that the PQME reports were not substantial medical evidence, and that the claim was barred by laches. The Board granted reconsideration and affirmed the F&O, amending only to correct a clerical error on the application filing date and to find applicant's date of cumulative injury for all body parts is November 4, 2019. The Board reasoned that knowledge of symptoms is not knowledge of industrial causation, the PQME reports constituted substantial medical evidence, and laches was waived because it was not raised at trial and no prejudice was shown.

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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