WCPanelIQ
PanelQMEMed-legalDenied

Maria Garcia — ADJ11380772, ADJ12825012

MARIA GARCIA, Applicant vs. PAE APPLIED TECHNOLOGIES LLC; ACE AMERICAN INSURANCE COMPANY, administered by ESIS, Defendants

ADJ number
ADJ11380772, ADJ12825012
Decision date
Jul 26, 2021
District office
Santa Ana
WCJ
Richard P. Brennen
Claim administrator
ESIS (administering for ACE American Insurance Company)
Commissioners
—

Injury / body parts: back, shoulders, eyes/vision, forearms, wrists, elbows, hands, fingers

LC §5402LC §5701LC §5906LC §3202LC §5405LC §5709CCR §10492CCR §10517

Summary

Applicant Maria Garcia, a packer, alleged a cumulative trauma injury (ADJ11380772, May 1, 2017 to July 3, 2018) and a specific injury (ADJ12825012) involving being struck by a forklift and falling pallets. The PTP, Dr. Salomon, only addressed the CT injury, while QME Dr. Yu only addressed a specific injury, which he dated July 3, 2018, though applicant testified at trial the forklift incident actually occurred on August 6, 2017. The WCJ found the medical record required further development since neither report was substantial evidence as to the date(s) of injury, and that the statute of limitations did not bar the specific injury claim under equitable estoppel because the employer failed to provide a claim form or refer applicant for treatment. The defendant petitioned for reconsideration challenging these findings. The WCAB adopted the WCJ's report and denied reconsideration, affirming the Board's authority to amend pleadings to conform to proof and to develop the record.

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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