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PanelQMEGranted

Salazar, Jose

JOSE SALAZAR vs. KAISER PERMANENTE, permissibly self-insured; SEDGWICK, Defendants

ADJ number: ADJ15692843
Decision date: Sep 25, 2023
District office: Van Nuys
WCJ: —
Claim administrator: Sedgwick (administering for Kaiser Permanente, permissibly self-insured)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: COVID-19 infection, respiratory/lungs (restrictive lung disease), cognitive disorder, headache/migraine, loss of smell and taste, psyche (depression and anxiety)

LC §3202.5LC §4600LC §4604.5LC §4610.5LC §5307.27

Summary

Jose Salazar, a Kaiser pharmacy assistant, sustained an admitted industrial COVID-19 injury on March 22, 2020. After Kaiser's UR determination denying home health care was found untimely, the WCJ found Dr. Merman's reporting constituted substantial evidence and awarded home health care of four hours per day, five days per week to assist with activities of daily living. Defendant sought reconsideration, arguing the evidence failed to establish entitlement because Dr. Merman never assessed applicant's symptomatology against the MTUS criteria. The Appeals Board granted reconsideration, holding that Dr. Merman's reports did not explain how applicant's symptomatology met applicable treatment criteria and failed to specify the type and duration of home health services. The Board rescinded the F&A and remanded for development of the record.

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.