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PanelQMEMed-legalDenied

Marcia Mc Crea — ADJ12385071

MARCIA McCREA, Applicant vs. ADELANTO ELEMENTARY SCHOOL DISTRICT, permissibly self-insured member of CSRM JPA, administered by YORK RISK SERVICES GROUP, a SEDGWICK COMPANY, Defendants

ADJ number
ADJ12385071
Decision date
Jul 28, 2022
District office
Anaheim
WCJ
Katharine Holmes
Claim administrator
York Risk Services Group, a Sedgwick Company (administering for Adelanto Elementary School District, permissibly self-insured member of CSRM JPA)
Commissioners
—

Injury / body parts: back, cervical spine, nervous system, other body systems

LC §5803LC §5900LC §5903CCR §10850

Summary

Applicant Marcia McCrea filed both a specific injury claim (6/25/19) and a cumulative trauma (CT) claim (1/9/09-7/19/19) involving her back, cervical spine, and other body systems. Based on QME Dr. Georgis's June 25, 2020 report that did not identify a CT injury, applicant stipulated to dismiss the CT claim without prejudice, with the order signed December 1, 2020. After the stipulation was filed but before/around the dismissal, Dr. Georgis issued an October 26, 2020 supplemental report attributing 10% of the cervical disability to the CT, later affirmed in a March 31, 2021 report after reviewing new diagnostic studies. The WCJ found the intervening change in the QME's opinion constituted good cause to reopen under Labor Code section 5803 and granted applicant's petition to vacate the dismissal. The WCAB denied defendant's Petition for Reconsideration, adopting the WCJ's report except for the windfall discussion, and clarified that potential overlapping awards or differing liable entities did not preclude reopening.

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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