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PanelQMEMed-legalGranted in Part

Maria Maravilla — ADJ13446350

MARIA MARAVILLA, Applicant vs. DEL MONTE FOODS and PROPERTY & CASUALTY INSURANCE COMPANY administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants

ADJ number: ADJ13446350
Decision date: Oct 26, 2021
District office: Stockton
WCJ: —
Claim administrator: Sedgwick Claims Management Services, Inc.
Commissioners: MARGUERITE SWEENEY, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: right wrist, right forearm, neck, low back

LC §4062.3LC §4064LC §5701LC §5906CCR §35.5

Summary

Applicant Maria Maravilla, in pro per, sought reconsideration of an F&A finding she sustained a right wrist and right forearm injury causing 12% permanent disability while working as a warehouse worker for Del Monte Foods on August 16, 2019. Applicant claimed her back, waist, and arm were never treated and disputed the 12% rating. QME Dr. Char diagnosed chronic neck and low back pain but declined to address causation for those body parts because they were not admitted, no treatment was provided, and no diagnostics performed. The Board held that a medical-legal evaluator must address whether an injury is industrial when body parts are claimed and denied, making Dr. Char's report not substantial evidence on the AOE/COE issue. The Board granted reconsideration, affirmed the 12% PD stipulation for the wrist/forearm, but deferred the neck and low back injury, PD, medical treatment, and TD issues and remanded for further development of the record.

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.