WCPanelIQ
PanelQMEMed-legalDenied

Vela, Roberto

ROBERTO VELA, Applicant vs. MARATHON PETROLEUM COMPANY; OLD REPUBLIC INSURANCE, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants

ADJ number
ADJ16546628
Decision date
Feb 25, 2024
District office
Marina del Rey
WCJ
—
Claim administrator
Sedgwick Claims Management Services, Inc., administering for Old Republic Insurance
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: lumbar spine, finger

LC §4060LC §4062.3LC §4064LC §5401LC §5703CCR §35.5

Summary

Applicant Roberto Vela, a machinist for Marathon Petroleum, sustained a specific injury on March 21, 2022 when he tripped over a hose, and claimed injury to his lumbar spine. Defendant accepted the finger laceration but denied the lumbar spine, relying on treating physician Dr. Feiwell's opinion that the back complaints were the result of a cumulative trauma rather than the specific injury. The QME in the specific claim, Dr. Krishnareddy, opined applicant's lumbar injury was mainly from the work fall. Defendant sought to take the matter off calendar (OTOC) to obtain a pending QME report from Dr. Feldman in a companion cumulative trauma claim, arguing due process required addressing all injuries before trial. The WCJ proceeded to trial, found a lumbar spine injury from the specific event, and denied the OTOC request. The Board denied reconsideration, holding under Navarro that a different QME for the subsequent cumulative claim was proper and that Dr. Feldman's report would only be additional evidence, not a QME report in the specific claim.

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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