WCPanelIQ
PanelQMEMed-legalDenied

Hernandez, Roberta

ROBERTA HERNANDEZ, Applicant vs. VENTURA POST ACUTE; STARSTONE NATIONAL INSURANCE COMPANY, Administered By CANNON COCHRAN MANAGEMENT SERVICES, INC., Defendants

ADJ number
ADJ13064691
Decision date
Oct 15, 2023
District office
Oxnard
WCJ
—
Claim administrator
Cannon Cochran Management Services, Inc. (administering for StarStone National Insurance Company)
Commissioners
—

Injury / body parts: back, lumbar spine

LC §5909LC §4660.1

Summary

Roberta Hernandez, a medical records director, sustained an industrial back injury on August 21, 2019 after falling, with QME orthopedist Dr. Brian Grossman assigning 30% WPI and significant work restrictions. Applicant's vocational expert (P. Steve Ramirez) opined she was not employable or amenable to vocational rehabilitation based on those work restrictions, while the WCJ initially found only 45% permanent partial disability. On reconsideration, the Board majority found applicant rebutted the scheduled rating under LeBoeuf/Ogilvie and found permanent total (100%) disability. The Board then denied defendant's subsequent petition for reconsideration, rejecting Dr. Grossman's apportionment opinion as not constituting substantial medical evidence under Escobedo. Commissioner Razo dissented, arguing the vocational evidence overstated the work restrictions and that chronic pain is already accounted for in the AMA Guides.

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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