WCPanelIQ
PanelQMEMed-legalGranted in Part

Ezechiel Banales — ADJ10941537, ADJ8480583

EZECHIEL BANALES, Applicant vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS & REHABILITATION, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ10941537, ADJ8480583
Decision date
Jan 12, 2022
District office
Salinas
WCJ
—
Claim administrator
State Compensation Insurance Fund (administrator for legally uninsured State of California Department of Corrections & Rehabilitation)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, DEIDRA E. LOWE, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: lumbar spine, cervical spine, right wrist and hand, ears (hearing loss/tinnitus)

LC §5952LC §4664LC §5701LC §5906

Summary

Applicant Ezechiel Banales sought reconsideration of a Joint Findings and Award that found no new and further permanent disability in his 2012 injury claim (ADJ8480583) and 50% permanent disability for his cumulative injury through May 10, 2017 (ADJ10941537). The Board affirmed the finding of no new and further disability, agreeing with the WCJ that QME Dr. Gagnon never opined the 2012 injury produced new and further disability and that the hearing loss impairment (11%) was less than the prior 14% award. However, the Board found Dr. Gagnon's apportionment opinions in ADJ10941537 did not comply with Escobedo because he failed to explain the basis for his percentages, so the reports were not substantial evidence. The Board therefore deferred the permanent disability determination in ADJ10941537 and remanded for development of the record, recommending a supplemental report from Dr. Gagnon. The Board also clarified that apportionment must be applied to each body part's rating string before combining via the CVC, not after.

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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