WCPanelIQ
PanelQMELienDenied

Zambrana, Esperanza

ESPERANZA ZAMBRANA, Applicant vs. STATE OF CALIFORNIA- IHSS, legally uninsured; administered by INTERCARE HOLDINGS INSURANCE, Defendants

ADJ number
ADJ14989612
Decision date
Sep 27, 2023
District office
San Francisco
WCJ
Elizabeth Dehn
Claim administrator
Intercare Holdings Insurance
Commissioners
—

Injury / body parts: neck, cervical spine, back, low back

LC §4663LC §3202.5LC §5902CCR §10940

Summary

Applicant Esperanza Zambrana, an IHSS caretaker, sustained a stipulated industrial injury to her neck and back on April 21, 2020 from a fall at work, requiring an emergency room visit and cervical spine surgery two days later. The PQME, Dr. Bestard, opined that the fall increased her neck symptoms requiring surgery, but also opined that her spinal condition would have required surgery regardless of the fall. The WCJ found these apportionment opinions contradictory and inconsistent and therefore not substantial evidence, awarding 47% unapportioned permanent disability. Defendant petitioned for reconsideration, arguing the QME's opinions were substantial evidence, that the record should have been developed further, and that the WCJ failed to render a causation finding. The WCAB denied reconsideration, adopting the WCJ's report and concluding that because defendant failed to meet its burden on apportionment, applicant was entitled to an unapportioned 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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