WCPanelIQ
PanelQMEMed-legalLienDenied

Sanchez, Fatima

FATIMA SANCHEZ, Applicant vs. SUNFLOWER GARDENS; ACCIDENT FUND INSURANCE CO. OF AMERICA, administered by UNITED WISCONSIN INSURANCE NEW BERLIN, Defendants

ADJ number
ADJ14570760
Decision date
Nov 16, 2025
District office
Long Beach
WCJ
Denise Kuper
Claim administrator
United Wisconsin Insurance New Berlin, administering for Accident Fund Insurance Co. of America
Commissioners
—

Injury / body parts: respiratory system, lungs, COVID-19

LC §4656LC §4650LC §4616.2LC §5909LC §5900LC §3202LC §3202.5LC §5705LC §4903LC §4904

Summary

Applicant Fatima Sanchez sustained an admitted industrial injury on June 16, 2020, to her respiratory system from COVID-19 while working at a memory care facility, requiring two hospitalizations and leaving her with chronic post-COVID respiratory symptoms. After defendant paid 104 weeks of temporary total disability (TTD), the dispute centered on whether applicant had a 'chronic lung disease' under Labor Code section 4656(c)(3)(I), entitling her to up to 240 weeks of TTD. The WCJ found applicant had a chronic lung disease based on the reporting of treating physician Dr. Miller, internal medicine QME Dr. Ellis, and pulmonary QME Dr. Lineback, and awarded extended TTD up to 240 weeks within five years of injury, less the 104 weeks already paid. The Board denied reconsideration, rejecting defendant's 'magic words' argument that physicians must specifically use the phrase 'chronic lung disease,' holding that the medical reporting taken as a whole constituted substantial medical evidence. The Board also affirmed that defendant was not entitled to EDD credit because EDD withdrew its lien and no reimbursement was made.

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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