WCPanelIQ
PanelQMEMed-legalDenied

Donna Puga — ADJ11641128, ADJ11641129

DONNA PUGA, Applicant vs. SEDGWICK CLAIMS MANAGEMENT SERVICES and PROPERTY & CASUALTY INSURANCE COMPANY OF HARTFORD, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ11641128, ADJ11641129
Decision date
Jan 26, 2023
District office
Van Nuys
WCJ
Clint Feddersen
Claim administrator
Sedgwick Claims Management Services (administering for Property & Casualty Insurance Company of Hartford)
Commissioners
—

Injury / body parts: psyche, cervical spine, bilateral elbows, bilateral carpal tunnel syndrome

LC §3208.3LC §5313LC §5813LC §5900LC §5902LC §5903LC §5904

Summary

Applicant Donna Puga, a claims adjuster, claimed a psychiatric injury (ADJ11641129) and orthopedic injuries (ADJ11641128) during overlapping cumulative trauma periods. The psychiatric QME, Dr. Yatin Patel, attributed 45% of causation to harassment, humiliation, and a hostile work environment, 30% to a combination of personnel actions, and 25% to outside factors, finding actual employment events were the predominant cause. The WCJ found a compensable psychiatric injury AOE/COE with no temporary or permanent disability but awarded further medical treatment, and rejected the good faith personnel action defense. Defendant sought reconsideration arguing the section 3208.3 threshold was not met and that the section 3208.3(h) defense produced 55% non-industrial causation. The Board, adopting the WCJ's Report, affirmed, holding harassment and hostile work environment are not good faith personnel actions and the 30% personnel-action causation was insufficient to meet the 'substantial cause' threshold to bar the claim.

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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