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Matha Ortega — ADJ8827235

MARTHA ORTEGA, Applicant vs. GIB 10, INC. dba JIM’S BURGERS; STAR INSURANCE COMPANY and BENCHMARK INSURANCE COMPANY are administered by ILLINOIS MIDWEST AGENCY, LLC, Defendants

ADJ number
ADJ8827235
Decision date
Jul 10, 2022
District office
Los Angeles
WCJ
Jerilyn Cohen
Claim administrator
Illinois Midwest Agency, LLC
Commissioners
—

Injury / body parts: cervical spine, lumbar spine, right knee, left knee, psyche, internal/gastrointestinal (reflux disorder), hypertension, diabetes

LC §5900LC §5902LC §5903

Summary

Applicant Martha Ortega, a dishwasher/cleaner, claimed injury to her cervical spine during a cumulative trauma period (3-17-09 to 3-17-10), in addition to admitted injuries to other body parts. Injury to the cervical spine was the contested issue, with QME Dr. Lee Silver finding no industrial injury and deferring causation to the trier of fact, while PTP Dr. Mark Spoonamore found industrial cervical injury. The WCJ found Dr. Spoonamore's reports more persuasive and substantial evidence, while finding Dr. Silver's opinions deficient and not substantial evidence. Defendant Benchmark Insurance Company petitioned for reconsideration, arguing the WCJ erred in weighing both physicians' reports. The WCAB adopted and incorporated the WCJ's report, citing Place v. WCAB for the principle that one physician's opinion may constitute substantial evidence even if inconsistent with others, and denied reconsideration.

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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