GRISELDA GONZALEZ, Applicant vs. G6 HOSPITALITY; LIBERTY MUTUAL INSURANCE COMPANY, Adjusted By HELMSMAN MANAGEMENT SERVICES, Defendants
ADJ number
ADJ11344091
Decision date
Nov 1, 2021
District office
San Jose
WCJ
—
Claim administrator
Helmsman Management Services (for Liberty Mutual Insurance Company)
Commissioners
—
Injury / body parts: right knee, lumbar spine, right foot, left knee (claimed)
Summary
Applicant Griselda Gonzalez, a housekeeper, was struck by a truck in a parking lot on May 1, 2018, sustaining injury to her right knee, right foot, and lumbar spine. The WCJ found 24% permanent disability and need for further medical treatment, relying on the PR-4 of primary treating physician Dr. Kaisler-Meza rather than the PQME reports of Dr. Owen. Defendant sought reconsideration, arguing Dr. Kaisler-Meza's report was not substantial evidence (citing outdated and inaccurate measurements and reliance on telemedicine) and that PQME Owen's reports should be followed. The Board denied reconsideration, adopting the WCJ's Report, finding that PQME Owen failed to review any of the three MRIs and unreasonably concluded there was no 'adequate' documentation of low back involvement despite an admitted lumbar injury, treatment, and a lumbar MRI. The Board noted that both physicians ascribed 7% WPI to the right knee, with the difference coming from Dr. Kaisler-Meza's additional finding of lumbar injury rated using the Diagnosis-Related Estimates method.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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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.