WCPanelIQ
PanelQMEMed-legalGranted in Part

Mario Acosta — ADJ1565410, ADJ916013

MARIO ACOSTA, Applicant vs. ACME CORPORATION; SUBSEQUENT INJURIES BENEFITS TRUST FUND, Defendants

ADJ number
ADJ1565410, ADJ916013
Decision date
Sep 15, 2021
District office
Salinas
WCJ
—
Claim administrator
—
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, DEIDRA E. LOWE, COMMISSIONER

Injury / body parts: left shoulder, right shoulder, brain (traumatic brain injury), heart (coronary artery disease), cardiovascular (hypertension), endocrine (diabetes), hearing, smell

LC §4751LC §5100.5LC §5313LC §5903LC §5952LC §4622CCR §10566

Summary

Applicant Mario Acosta sought Subsequent Injuries Benefits Trust Fund (SIBTF) benefits based on a 2006 left shoulder injury (awarded 23% PD) combined with preexisting disabilities including a 1995 right shoulder injury, internal diseases (diabetes, hypertension, coronary artery disease), and a 2002 brain injury (awarded 75% PD). The WCJ found applicant entitled to SIBTF benefits and permanently totally disabled, but SIBTF sought reconsideration on multiple grounds including insufficiency of findings, failure to prove the 5% opposite-and-corresponding threshold, failure to prove a labor-disabling preexisting disability, and improper reliance on an unadmitted medical report (Dr. Malhotra). The WCAB granted reconsideration, rescinded the Findings and Award, and substituted findings that applicant sustained an industrial injury and that the SIBTF claim was not barred by any limitations period, deferring all other issues. The Board concluded the original Findings and Award lacked the specific findings required by section 5313 to support SIBTF eligibility, including failure to identify the subsequent disability percentage, the preexisting injuries and their percentages, and whether the preexisting disabilities were labor disabling at the time of the subsequent injury.

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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