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David Matthews — ADJ14069848

DAVID MATTHEWS, Applicant vs. SIMI VALLEY CYCLES; AMGUARD INSURANCE COMPANY, Defendant

ADJ number
ADJ14069848
Decision date
Dec 22, 2022
District office
Van Nuys
WCJ
—
Claim administrator
AmGUARD Insurance Company
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER, MARGUERITE SWEENEY, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: cervical spine, bilateral shoulders, left arm, elbows

LC §3208.1

Summary

Applicant David Matthews, a motorcycle mechanic, originally claimed a November 21, 2020 specific injury to his neck, amended to add a cumulative trauma claim, then amended back to allege only a specific injury based on PQME Dr. Clive Segil's report. PQME Dr. Segil's unrebutted opinion found the cervical spine, bilateral shoulders, and bilateral elbows industrially related to the November 21, 2020 specific incident, when applicant felt a 'pop' in his neck while leaning forward on a motorcycle during a test ride. Despite the parties' stipulation to a specific injury and unrebutted medical evidence, the WCJ issued a Findings and Award finding injury 'on November 21, 2020 and/or during the period August 2020 through November 21, 2020,' based on her own view that the conditions were degenerative and developed over time. The Board granted reconsideration, holding the WCJ improperly substituted her lay opinion for the only medical opinion in evidence. The decision was amended to find only a specific November 21, 2020 injury, deleting any reference to a cumulative injury not raised by the operative pleadings.

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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