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PanelQMEMed-legalLienDenied

Rosario Rodriguez — ADJ11914002

ROSARIO RODRIGUEZ, Applicant vs. SAN MATEO COUNTY TRANSIT DISTRICT, PERMISSIBLY SELF INSURED, ADMINISTERED BY THE CITIES GROUP, Defendants

ADJ number
ADJ11914002
Decision date
Apr 21, 2022
District office
San Francisco
WCJ
—
Claim administrator
The Cities Group (administrator for San Mateo County Transit District, permissibly self-insured)
Commissioners
CRAIG SNELLINGS, COMMISSIONER, DEIDRA E. LOWE, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: lumbar spine, low back, right lower extremity (radiculopathy), sacrum (sacral ala fracture)

LC §4656LC §3200LC §3201

Summary

Applicant, a bus operator, claimed a low back injury on October 17, 2018 from twisting to check on passengers. Defendant initially denied the claim but later accepted liability while repeatedly delaying TTD payment pending additional documentation and a supplemental AME report on causation/apportionment relating to an incidentally discovered ovarian papillary projection. The WCJ awarded TTD from October 25, 2018 to October 22, 2020 (capped at 104 weeks under section 4656(c)(2)), less EDD reimbursement and attorney fees, and overruled defendant's objection that trial was premature. On reconsideration, the Board held that the WCJ properly allowed the expedited hearing to proceed because defendant had already admitted and stipulated to injury AOE/COE, the AME reporting constituted substantial evidence, and the prejudice to applicant from continued delay outweighed defendant's due process discovery interest. The F&A was affirmed.

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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