WCPanelIQ
PanelQMEMed-legalDenied

Rebecca Gray — ADJ11554890

REBECCA GRAY, Applicant vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND, Defendants

ADJ number
ADJ11554890
Decision date
Jul 4, 2022
District office
San Jose
WCJ
Adoralida Padilla
Claim administrator
Subsequent Injuries Benefits Trust Fund
Commissioners
—

Injury / body parts: cervical spine, right shoulder, right wrist, left shoulder

LC §4751

Summary

Applicant Rebecca Gray sustained an industrial injury to her cervical spine, right shoulder, and right wrist while employed as an administrative associate. After the case-in-chief resolved by Compromise and Release, applicant pursued SIBTF benefits, and the WCJ found a pre-existing left shoulder disability (an opposite and corresponding member to the injured right shoulder) and that the subsequent injury disability exceeded the 5% SIBTF threshold. SIBTF sought reconsideration, arguing that the PQME, Dr. Sabsovich, found full range of motion in the left shoulder and therefore the finding of pre-existing left shoulder disability was not substantial evidence, and that the 5% opposite-and-corresponding threshold was not met. The WCAB adopted the WCJ's Report and denied reconsideration, finding Dr. Chen's 3% left shoulder impairment was supported by a documented ten-year history of complaints, diagnostic imaging showing a tear and bursitis, and work restrictions. The Board also held that under SIF v. WCAB (Post), the 5% threshold need not be reached by the opposite and corresponding member itself, only that such a member be involved and the overall subsequent injury disability reach 5%.

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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