WCPanelIQ
PanelQMEMed-legalAffirmed

McDaniel, James

JAMES MCDANIEL, Applicant vs. CITY OF SACRAMENTO, permissibly self-insured, administered by OD LEGAL, Defendant

ADJ number
ADJ11331456
Decision date
Nov 28, 2023
District office
Sacramento
WCJ
—
Claim administrator
OD Legal (administrator for City of Sacramento, permissibly self-insured)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, ANNE SCHMITZ, DEPUTY COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: heart, circulatory system, coronary artery (left main coronary artery aneurysm)

LC §5701LC §5900LC §5903LC §4062.3LC §5915CCR §10605CCR §10600CCR §10940CCR §10615CCR §10964

Summary

Firefighter James McDaniel claimed an October 31, 2017 industrial injury to his heart/circulatory system, and the WCJ found 56% permanent disability based on the reports of internal medicine QME Dr. Roger Nacouzi, who placed applicant at the high end of Class 2 (29% WPI) under AMA Guides Table 3-6a. Defendant sought reconsideration, arguing Dr. Nacouzi's opinions were not substantial evidence and that defendant was entitled to a regular physician under Labor Code section 5701. The Board first addressed the timeliness of the petition, accepting defendant's supplemental pleading and declarations establishing the F&A was not received until March 28, 2022, deeming the petition timely. On the merits, the Board held Dr. Nacouzi's opinions constituted substantial medical evidence and found no good cause to appoint a regular physician or replacement QME. The Board affirmed the Findings and 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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