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PanelQMEMed-legalGranted

Padilla, Maria Elena

MARIA ELENA PADILLA, Applicant vs. JACK IN THE BOX; ACE AMERICAN INSURANCE, ADMINISTERED BY GALLAGHER BASSETT SERVICES, Defendants

ADJ number: ADJ11410257
Decision date: Oct 23, 2023
District office: Los Angeles
WCJ: —
Claim administrator: Gallagher Bassett Services (administering for ACE American Insurance)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, NATALIE PALUGYAI, COMMISSIONER

Injury / body parts: various body parts

LC §3600LC §3207LC §4628LC §4062.3LC §4064LC §5703LC §5705LC §5708LC §5313LC §5901LC §5903LC §5907LC §5908LC §5908.5LC §5950LC §5952LC §5803

Summary

Applicant Maria Elena Padilla sought reconsideration of an August 8, 2023 F&O in which the WCJ found she did not sustain industrial injury (AOE/COE) and ordered her to take nothing, based on a finding that QME orthopedic surgeon Dr. Michael Smith's reporting was not substantial evidence because it lacked an accurate injury history. The WCAB granted reconsideration, finding the WCJ failed to conduct a full Tensfeldt fraud analysis, did not make a clear ruling on the admissibility of Dr. Smith's reporting under Labor Code section 4628, and did not adequately develop the record. The Board deferred issuance of a final decision pending further review and indicated the matter would likely be returned to the trial level. The grant reopens the entire record for the Board's continuing jurisdiction.

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.