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PanelQMEDenied

Martha Correa — ADJ10755478

MARTHA CORREA, Applicant vs. VOLT SERVICES GROUP; GALLAGHER BASSETT SERVICES, Defendants

ADJ number
ADJ10755478
Decision date
Apr 25, 2021
District office
Oxnard
WCJ
Robert M. Mays
Claim administrator
Gallagher Bassett Services
Commissioners
—

Injury / body parts: left shoulder

CCR §10945CCR §10842

Summary

Applicant Martha Correa suffered an admitted left shoulder injury during a cumulative trauma period from 10/24/2015 to 10/24/2016. The PQME, Dr. Lundeen, found her MMI on 5/8/2019, and defendant terminated TTD on 5/27/2019 seeking overpayment credit, while the treating physician (Dr. Behrman/Brourman) disagreed and felt she remained TTD pending further non-surgical treatment. The WCJ found applicant continued to be TTD because the PQME's MMI finding appeared based largely on applicant's expressed desire at the exam to settle and avoid surgery, while ongoing UR/IMR-approved treatment continued and the PQME himself later ratified that treatment as reasonable and necessary. The WCAB denied defendant's Petition for Reconsideration, adopting and incorporating the WCJ's report, and admonished defense counsel for attaching documents already in the record in violation of WCAB Rule 10945.

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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