WCPanelIQ
PanelQMEMed-legalDenied

Rose Herrera — ADJ11087566

ROSA HERRERA, Applicant vs. KAISER FOUNDATION HOSPITAL, Permissibly Self-Insured, Adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ11087566
Decision date
May 12, 2021
District office
Oakland
WCJ
—
Claim administrator
Sedgwick Claims Management Services (TPA for Kaiser Foundation Hospital, Permissibly Self-Insured)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, KATHERINE WILLIAMS DODD, COMMISSIONER, MARGUERITE SWEENEY, COMMISSIONER
LC §5909LC §5903LC §5903(d)CCR §10974

Summary

Defendant Kaiser (self-insured, administered by Sedgwick) sought reconsideration of a December 21, 2020 Decision After Reconsideration in which the Appeals Board found applicant Rosa Herrera entitled to temporary total disability from May 28, 2020 to September 17, 2020 and deferred entitlement after that date. Defendant argued the award lacked substantial medical evidence, that newly discovered evidence (a post-hearing PQME report and a pre-hearing Dr. Bokarius report received late) showed no disability, and that the WCJ's finding on applicant's credibility undermined the award. The Board found its time to act tolled under Shipley because the petition did not reach the Board until after the 60-day period due to no fault of the parties. The Board held the PTP's contemporaneous reports constituted substantial medical evidence more persuasive than the stale PQME reporting and that defendant failed to demonstrate the newly discovered evidence could not have been produced earlier. Reconsideration was denied.

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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