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Armando Diaz Espinoza — ADJ14080327

ARMANDO DIAZ ESPINOZA, Applicant vs. SMITH GARDENS, INC.; FLORISTS’ MUTUAL INSURANCE COMPANY, administered by SENTRY CLAIMS SERVICE, Defendants

ADJ number
ADJ14080327
Decision date
Oct 4, 2021
District office
Salinas
WCJ
—
Claim administrator
Sentry Claims Service (administering for Florists' Mutual Insurance Company)
Commissioners
MARGUERITE SWEENEY, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: left shoulder, cervical spine, back, hips, arm

LC §4060LC §4061LC §4062LC §4062.2LC §4610LC §5702LC §5904CCR §30CCR §10507CCR §10605

Summary

Applicant Armando Diaz Espinoza claimed injury to multiple body parts, but defendant accepted only the left shoulder and cervical spine. After applicant filed his Application, defendant sent a January 20, 2021 'Objection to Application' letter disputing the additional body parts (arm, back, hip). Applicant used that letter to obtain a QME panel in physical medicine, while defendant later obtained its own orthopedic QME panel based on a February 4, 2021 letter objecting to a treating physician's report. The WCAB rescinded the WCJ's F&O, holding that defendant's January 20 letter was not a valid basis for a panel under section 4061 because it did not object to a treating physician's medical determination, making applicant's panel invalid. Defendant's February 4 letter properly objected to a treating physician report and its panel request was timely, so defendant's panel (No. 7393277) was found valid and the parties were ordered to use it.

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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