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PanelQMEDenied

Reisinger, Scott

SCOTT REISINGER, Applicant vs. TUCKER LATH & PLASTERING; EVEREST PREMIER INSURANCE COMPANY, adjusted by AMERICAN CLAIMS MANAGEMENT, Defendants

ADJ number: ADJ15225348
Decision date: Dec 11, 2023
District office: Oakland
WCJ: Erin Finnegan
Claim administrator: American Claims Management (adjusting for Everest Premier Insurance Company)
Commissioners: —

Injury / body parts: right shoulder

LC §4660.1

Summary

Applicant Scott Reisinger, a 55-year-old lather/plasterer, sustained a specific right shoulder injury on June 21, 2021, rupturing three of four rotator cuff tendons and the intra-articular biceps tendon, requiring two surgeries including an unsuccessful subscapularis revision. PQME Dr. Rommel Hindocha provided a strict AMA Guides rating of 32% and an Almaraz/Guzman rating of 74%, and the WCJ found the Almaraz/Guzman rating to be substantial medical evidence. Defendant petitioned for reconsideration, arguing the Almaraz/Guzman rating was not substantial medical evidence because Dr. Hindocha failed to explain why the strict rating did not apply. The WCAB adopted the WCJ's Report and Opinion and denied reconsideration, finding Dr. Hindocha adequately explained the basis for departure from a strict rating (muscle atrophy, unsuccessful revision surgery, 7/8 limited ADLs). The Board affirmed the 74% permanent disability award.

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.