WCPanelIQ
PanelQMEMed-legalDenied

Hyun Sook Lee — ADJ9372475, ADJ10047707

HYUN SOOK LEE, Applicant vs. MAKESHOPNCOMPANY, INC.; ACE PROPERTY & CASUALTY INSURANCE, administered by ESIS; SAMSUNG FIRE & MARINE INSURANCE, administered by BROADSPIRE, Defendants

ADJ number
ADJ9372475, ADJ10047707
Decision date
Mar 13, 2022
District office
Los Angeles
WCJ
—
Claim administrator
ESIS (administering ACE Property & Casualty Insurance); Broadspire (administering Samsung Fire & Marine Insurance)
Commissioners
DEIDRA E. LOWE, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: cervical spine, lumbar spine, thoracic spine, right shoulder, right elbow, right hand, right wrist, bilateral knees, psyche, upper gastrointestinal system, lower gastrointestinal system, cardiovascular system, sleep disorder, high blood pressure

LC §4453LC §4060LC §4062.2LC §4659LC §4660LC §4660.1LC §4662LC §4663LC §4664LC §5412LC §5500.5LC §5502LC §5705LC §5903LC §5952

Summary

Applicant, a customer service manager, claimed a specific injury (April 18, 2012, fall from a ladder) and a cumulative trauma injury to multiple body parts. The WCJ awarded 100% permanent disability without apportionment and found the CT injury ended March 5, 2013. Co-defendant Ace sought reconsideration, arguing the evidence did not support 100% PD, that apportionment was warranted, that the CT date should be April 8, 2013, and that it should have been permitted its own orthopedic QME panel. The Board affirmed, finding the AME's opinion that the disability sources were inextricably intertwined and the Hikida-based finding that failed back syndrome from surgery was the sole cause of the lumbar disability supported the unapportioned 100% award. The Board also held that disability and knowledge of industrial causation occurred March 5, 2013 (the surgery date), and that Ace failed to exercise due diligence in pursuing its own QME panel.

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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