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PanelQMEMed-legalLienRemanded

Jose Vallarta Covarrubias — ADJ11505778, ADJ11256912

JOSE VALLARTA COVARRUBIAS, Applicant vs. BODAS CONSTRUCTION, INC.; NEW YORK MARINE AND GENERAL INSURANCE COMPANY, administered by LWP CLAIMS SOLUTIONS, INC.; WESCO INSURANCE COMPANY, administered by AMTRUST NORTH AMERICA, Defendants

ADJ number: ADJ11505778, ADJ11256912
Decision date: Mar 24, 2022
District office: Oxnard
WCJ: William M. Carero
Claim administrator: LWP Claims Solutions, Inc. (administering New York Marine and General Insurance Company); AmTrust North America (administering Wesco Insurance Company)
Commissioners: —

Injury / body parts: neck, back

LC §3208.1LC §5952LC §5953LC §5906CCR §9793

Summary

Lien claimant Bell Community Medical Center sought reconsideration of a WCJ decision disallowing its medical treatment lien based on findings that applicant did not sustain an industrial injury (specific in December 2012 or cumulative from 2000-2017). The WCJ relied on PQME Dr. Schwartz's report to disallow the lien. The Board majority found that Dr. Schwartz's report was not substantial medical evidence because it addressed only the specific injury claim and failed to analyze applicant's job duties or whether repetitive activities caused a cumulative injury. The Board granted reconsideration, rescinded the Findings and Order, and returned the matter to the trial level for development of the record. Commissioner Snellings dissented, adopting the WCJ's Report which found Dr. Schwartz's 18-page report well-supported and substantial.

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.