WCPanelIQ
PanelGranted

Fernando Muniz Villalpando — ADJ7950339, ADJ2396484

FERNANDO MUNIZ VILLALPANDO, Applicant vs. DOHERTY BROTHERS; MARTIN DUSTERS; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ7950339, ADJ2396484
Decision date
Aug 22, 2022
District office
Redding
WCJ
—
Claim administrator
State Compensation Insurance Fund
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, ANNE SCHMITZ, DEPUTY COMMISSIONER, MARGUERITE SWEENEY, COMMISSIONER

Injury / body parts: lumbar spine, cervical spine, bilateral shoulders, back, neck

LC §5900LC §5803LC §5804LC §5408LC §5307.5LC §5702CCR §10964

Summary

Applicant suffered industrial back, neck, and shoulder injuries in 2002, and all three cases were resolved by a Compromise and Release with an Order Approving issued August 24, 2011, which included a Medicare Set-Aside (MSA) account funded by a structured annuity purchased by SCIF and administered by a professional administrator, Bridge Pointe/NuQuest. Applicant, intending to permanently relocate to Mexico, sought to self-administer the MSA. The WCJ denied the request, finding the WCAB lacked jurisdiction because more than five years had passed (Lab. Code § 5804) and applicant had not shown fraud or extrinsic mistake, and that self-administration was not in his best interest. On reconsideration, the Appeals Board rescinded the F&O, holding that changing the MSA administrator is a ministerial act—not a modification of the award—and is therefore permitted under section 5803 beyond the five-year period, that applicant is competent to self-administer, and that Medicare's interests were considered. The Board granted self-administration and remanded for further proceedings.

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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