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Epifanio Medina — ADJ1413052, ADJ4567871

EPIFANIO MEDINA, Applicant vs. MATTHEW WILSON SPECIALTY CONTRACTOR’S, INC., dba SECOND NATURE, and MID-CENTURY INSURANCE COMPANY, Defendants

ADJ number
ADJ1413052, ADJ4567871
Decision date
Date unavailable
District office
Stockton
WCJ
—
Claim administrator
Mid-Century Insurance Company
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: left knee

LC §4610LC §4600LC §4616.3CCR §9792.6CCR §9780

Summary

Applicant Epifanio Medina sought reconsideration of a prior Appeals Board decision that had granted reconsideration, affirmed (with modifications) the amended Findings of Fact, found QME Dr. Hutchinson's reports were not substantial evidence in ADJ1413052, and deferred the permanent disability issue from the July 9, 2001 injury. Applicant argued that the issue of being referred to a specialist for left knee evaluation and his 'ongoing care' had been raised and should have been addressed. The Board found these issues were not raised at trial, were not submitted for decision, and that the mere discussion of treatment in admitted medical reports does not make an issue submitted for decision. The Board also noted that absent a request for authorization for an orthopedic specialist and subsequent utilization review, there was no basis to claim wrongful denial of treatment, and applicant already had an award of future medical care. Reconsideration was denied.

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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