WCPanelIQ
PanelQMEMed-legalGranted

Galvan, Walberto

WALBERTO GALVAN, Applicant vs. JC FARM MANAGEMENT; ZENITH INSURANCE COMPANY, Defendants

ADJ number
ADJ11231953
Decision date
Jun 4, 2023
District office
Fresno District Office
WCJ
Geoffrey H. Sims
Claim administrator
Zenith Insurance Company
Commissioners
—

Injury / body parts: arm, hand, wrist, jaw, teeth

LC §5402CCR §10786CCR §10451.1CCR §35.5CCR §35

Summary

Applicant Walberto Galvan sustained an accepted arm/wrist injury while pruning grapes; substitute counsel later added jaw and teeth to the claim. Dental QME Dr. David Abri evaluated applicant and addressed causation of dental conditions (bruxism, xerostomia/dry mouth) at applicant counsel's request, billing as an ML-104, but defendants refused payment citing their cover letter that directed him not to address causation. The WCJ found the medical-legal cost claim valid, concluding causation was properly addressed because applicant requested it and defendants requested apportionment (which necessarily requires causation analysis), and the dispute was a legal/medical-legal issue under CCR 10451.1 rather than an IBR dispute. The WCAB granted reconsideration to correct an erroneous finding (Finding No. 9) that no causation was discussed, amending it to reflect Dr. Abri's actual causation findings, and otherwise affirmed the award, clarifying that 'net' costs allows adjustment with credit to defendant subject to proof and reserved 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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