WCPanelIQ
PanelLienGranted in Part

Mauricio Martinez — ADJ10450982, ADJ10450937

MAURICIO MARTINEZ, Applicant vs. TITO’S MARKET; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ10450982, ADJ10450937
Decision date
Dec 9, 2021
District office
Santa Ana
WCJ
Robin Beth Leviton
Claim administrator
State Compensation Insurance Fund
Commissioners
—

Injury / body parts: eyes, hands/fingers, digestive system, right wrist

LC §4600LC §4903LC §5952CCR §9785

Summary

Lien claimant Optimal Health Institute litigated entitlement to payment for medical treatment provided to applicant Mauricio Martinez, who alleged a cumulative trauma injury (eyes, hands/fingers, digestive system) and a specific right wrist injury during his three-month employment at Tito's Market. The WCJ found that the lien claimant failed to prove injury AOE/COE because its medical reports were not substantial medical evidence—they contained contradictory injury histories, lacked diagnoses, described a 'specific' injury with gradual onset, and three acupuncture reports actually described a different patient (Elizabeth Cardoso) with entirely different body parts and dates of injury. The WCAB granted reconsideration solely to add an explicit finding that the lien claimant did not meet its burden of proof on AOE/COE, and otherwise affirmed. The Board adopted the WCJ's report and reasoning, declining to develop the record to allow the lien claimant to 'correct' its defective evidence.

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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