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PanelQMEMed-legalRemanded

Adame, Michael

MICHAEL ADAME, Applicant vs. LEK ENTERPRISES, INC.; SENTINAL INSURANCE, administered by THE HARTFORD, Defendants

ADJ number: ADJ19894287
Decision date: Aug 7, 2025
District office: Van Nuys
WCJ: —
Claim administrator: The Hartford (Sentinel Insurance Company, Ltd. - name to be confirmed; pleaded as 'Sentinal Insurance')
Commissioners: KATHERINE WILLIAMS DODD, COMMISSIONER, CRAIG L. SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: back, hips, ankle, diabetes, internal, psyche

LC §5909LC §5900LC §5903LC §5952LC §4663LC §4664LC §4060CCR §10390

Summary

Applicant Michael Adame, a plumber, claimed industrial injury to his back, hips, ankle, diabetes, internal, and psyche from an August 8, 2024 incident drilling on a ladder. The WCJ found applicant failed to meet his burden of proving industrial injury, relying heavily on credibility concerns including inconsistent injury dates and a pre-injury medical note showing low back pain. The Appeals Board granted reconsideration, holding that injury causation is a medical determination requiring substantial expert medical opinion, which was absent because the existing medical reports were flawed (notably failing to address a June 10, 2024 note documenting pre-existing low back pain). The Board rescinded the FF&O and remanded to develop the record via AME or PQME, and directed the WCJ to reconsider witness credibility once expert medical opinion is obtained. The Board also flagged the apparent misspelling of the insurer's name ('Sentinal' vs. 'Sentinel') for correction.

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.