PanelQMEMed-legalGranted in Part
Antonio Marquez — ADJ13326888, ADJ11986446
ANTONIO MARQUEZ, Applicant vs. ROMAN CATHOLIC BISHOP OF MONTEREY, permissibly self-insured, administered by LWP CLAIMS SOLUTIONS, INC., Defendants
- ADJ number
- ADJ13326888, ADJ11986446
- Decision date
- Oct 13, 2021
- District office
- Salinas
- WCJ
- —
- Claim administrator
- LWP Claims Solutions, Inc.
- Commissioners
- KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER
Injury / body parts: back, hernia, abdomen/groin, testicles, left leg, neck, right shoulder, right arm, right hand, right upper extremity, bilateral lower extremities
LC §4060LC §4061LC §4062LC §4062.2LC §4062.3LC §4064LC §4610LC §4610.5LC §4663LC §5401LC §5904CCR §30CCR §31.7CCR §35.5CCR §10396CCR §10955
Summary
Applicant Antonio Marquez sustained a 2018 specific injury (groin/back) evaluated by internal medicine QME Dr. Baum, and later filed a separate 2020 specific injury claim for which he obtained a chiropractic QME panel (Dr. Kirkwood). Dr. Baum requested an orthopedic evaluator to comment on applicant's back pain, and defendant obtained an additional orthopedic QME panel (Dr. Hellner) in the 2018 claim. Defendant argued under Navarro that the orthopedic QME, if seen first, should become the QME for both cases, and that he must consider all medical history. The Board affirmed that Dr. Kirkwood is the QME for the 2020 claim because the filing of a claim form is the operative act under Navarro, but amended the F&O to clarify that Dr. Hellner does not become the QME for the 2020 claim and must evaluate applicant per the Labor Code, including addressing all contested issues from all claim forms filed before his appointment. The order requiring Dr. Hellner to examine applicant only on issues identified by Dr. Baum was reversed.
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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