WCPanelIQ
PanelQMEMed-legalGranted in Part

Moises Jimenez — ADJ14232382

MOISES JIMENEZ, Applicant vs. PACIFIC CAMBRIA, INC.; EVEREST NATIONAL INSURANCE COMPANY, Defendants

ADJ number
ADJ14232382
Decision date
Sep 5, 2022
District office
San Luis Obispo
WCJ
—
Claim administrator
Sedgwick CMS (administering for Everest National Insurance Company)
Commissioners
—

Injury / body parts: left knee

LC §4663LC §5811

Summary

Applicant Moises Jimenez, a dishwasher/cook, sustained an industrial injury to his left knee on July 5, 2019 when he fell off barrels at work, ultimately requiring a total knee replacement with a poor result. QME orthopedist Dr. Scott Graham rated 30% WPI and apportioned 50% to pre-existing osteoarthritis based on epidemiological studies that individuals with knee osteoarthritis are symptomatic 50% of the time and asymptomatic 50% of the time. The WCJ rejected the apportionment and found 50% permanent disability without apportionment, but the Findings and Award failed to contain an actual Award. The Board affirmed the no-apportionment finding because Dr. Graham's opinion did not constitute substantial medical evidence, granted reconsideration to add the missing Award, and corrected a typographical error in the indemnity calculation.

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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