WCPanelIQ
PanelGranted in Part

Inez Martinez — ADJ2203864, ADJ7014519

INEZ MARTINEZ, Applicant vs. KAISER FOUNDATION HEALTH PLAN, permissibly self-insured and self-administered, Defendant

ADJ number
ADJ2203864, ADJ7014519
Decision date
Aug 10, 2022
District office
Los Angeles
WCJ
—
Claim administrator
Kaiser Foundation Health Plan (permissibly self-insured and self-administered)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, MARGUERITE SWEENEY, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: cervical spine, right shoulder, left shoulder, arms, wrists, hands, lumbar spine, right knee, left knee, gastrointestinal system/gastritis, psyche, chronic pain, headaches, sleep disorder, head, temporomandibular joint (TMJ), internal system, respiratory system, carpal tunnel syndrome, sexual dysfunction, feet

LC §3600LC §5900LC §5903LC §5909LC §5315CCR §10605CCR §10615CCR §10940

Summary

Applicant Inez Martinez claimed a cumulative trauma injury (10/29/2006–10/29/2007) while working as a Business Services Representative for self-insured Kaiser, plus a 10/1/2009 injury when she was struck by a car in the parking lot after leaving physical therapy for her industrial injury. The WCJ found multiple body parts injured and that the 2009 injury was a compensable consequence of the cumulative trauma. Defendant sought reconsideration, arguing applicant was not employed on 10/1/2009, the awarded TD period was not submitted for decision, and the record lacked substantial evidence for several body parts. The Board affirmed the F&A but amended findings to remove sleep disorder (found non-occupational per AME Dr. Betancourt) and to clarify that the 2009 injury was AOE/COE as a compensable consequence under Labor Code section 3600(a) because applicant was injured while leaving a medical appointment for the industrial injury.

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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