WCPanelIQ
PanelQMEMed-legalGranted

Lyle Cooper — ADJ12584448

LYLE COOPER, Applicant vs. ACE INSULATION; INSURANCE COMPANY OF THE WEST, Defendants

ADJ number
ADJ12584448
Decision date
Apr 24, 2022
District office
Santa Rosa
WCJ
—
Claim administrator
Insurance Company of the West
Commissioners
DEIDRA E. LOWE, COMMISSIONER, MARGUERITE SWEENEY, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: right foot, right fifth toe (pinky toe), right great toe, toes (amputation)

LC §3202.5LC §3600LC §5313LC §5400LC §5405LC §5411LC §5412LC §5502LC §5701LC §5900LC §5902LC §5903LC §5906LC §5952CCR §10566CCR §10605CCR §10843CCR §10955

Summary

Applicant Lyle Cooper, an insulation/HVAC installer with pre-existing diabetes and a prior 2014 right great toe amputation, alleged industrial injury to his right foot resulting in further toe amputations after developing a blister he attributed to employer-required work boots. The WCJ found applicant 'may' have sustained a cumulative injury ending April 19, 2019, met his burden of injury, that the claim was not barred by Labor Code sections 5400/5405, was not intentionally self-inflicted, and that there was insufficient evidence on the section 3600(a)(10) post-termination defense, ordering development of the record on whether medical records existed before the deemed termination date. Defendant ICW sought reconsideration arguing due process violation from the development order, failure to prove AOE/COE, and the post-termination bar. The Board granted reconsideration, finding the January 26, 2022 Findings and Order inadequate under section 5313 because it failed to determine whether the injury was specific or cumulative — a determination affecting burden of proof, statute of limitations, and the post-termination defense — and because the PQME's causation opinion lacked any supporting explanation. The Board rescinded the Findings and Order and returned the matter to the trial level for further proceedings.

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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