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PanelQMEDenied

Loyd Cox — ADJ11733612

LOYD COX, Applicant vs. RAMOS TANK LINES; NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, adjusted by GALLAGHER BASSETT, Defendants

ADJ number: ADJ11733612
Decision date: Apr 5, 2022
District office: Sacramento
WCJ: Noah W. Tempkin
Claim administrator: Gallagher Bassett (adjusting for National Union Fire Insurance Company of Pittsburgh, PA)
Commissioners: —

Injury / body parts: low back, left shoulder, left knee

LC §4663LC §4664LC §5952

Summary

Truck driver Loyd Cox sustained a specific injury on November 27, 2017 to his low back, left shoulder, and left knee. The sole issue on reconsideration was whether PQME Dr. Joel Weddington's apportionment opinion constituted substantial medical evidence. The WCJ found Dr. Weddington's apportionment (50/50 for low back and left knee, 75/25 for left shoulder) was substantial evidence because he took an accurate history, reviewed pertinent records, documented pre-existing degenerative changes, and explained the 'how' and 'why' of apportionment. The Appeals Board majority affirmed the December 31, 2021 Findings and Award (40% permanent disability), adopting and incorporating the WCJ's report. Chair Zalewski dissented, arguing that Dr. Weddington failed to adequately explain how he arrived at the assigned percentages and that characterizing the back and knee injuries as 'trivial' would support more than a 50/50 split.

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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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.