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Francisco Siles Rivas — ADJ10045593

FRANCISCO SILES RIVAS, Applicant vs. BRAKE LAND, LLC; TOWER INSURANCE COMPANY, In Liquidation, Administered By INTERCARE On Behalf of CALIFORNIA INSURANCE GUARANTEE ASSOCIATION; STAR INSURANCE, Administered By ILLINOIS MIDWEST; UNINSURED EMPLOYERS BENEFITS TRUST FUND, Defendants

ADJ number
ADJ10045593
Decision date
Sep 27, 2021
District office
Van Nuys
WCJ
—
Claim administrator
Intercare on behalf of California Insurance Guarantee Association (for Tower Insurance Company, in liquidation); Illinois Midwest (for Star Insurance)
Commissioners
—

Injury / body parts: trunk, hand, back, leg, upper extremity, lower extremity, psyche

LC §3208.1LC §5906

Summary

Applicant Francisco Siles Rivas, an automobile mechanic for Brake Land, LLC, claimed cumulative trauma injury to multiple body parts during a period ending July 10, 2015. A WCJ found no industrial injury based on credibility concerns. On reconsideration, the WCAB found the WCJ relied on facts largely immaterial to industrial causation (such as whether applicant was fired or quit, payment methods, and a clerical 2016 date error) and improperly invoked a post-termination defense never raised by defendants. Both the primary treating physician (Dr. Ashok) and the PQME (Dr. Lee) opined applicant sustained industrial injury, with Dr. Lee finding a lumbar strain at 2% WPI. The Board granted reconsideration, rescinded the F&O, and remanded for further development of the record, including clarification of credibility findings, whether a cumulative injury occurred, and apportionment analysis.

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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