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Mahjabin Sefat — ADJ12641877

MAHJABIN SEFAT, Applicant vs. ROSS STORES, INC.; ARCH INSURANCE COMPANY, Administered BY SEDGWICK CMS, Defendants

ADJ number
ADJ12641877
Decision date
Apr 18, 2021
District office
Van Nuys
WCJ
—
Claim administrator
Sedgwick CMS (administering for Arch Insurance Company)
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER

Injury / body parts: lumbar spine, cervical spine, right shoulder, right wrist, knees, psyche, nervous system, headaches

LC §3208.3LC §4060CCR §10517

Summary

Applicant retail associate alleged a specific injury on November 18, 2018 (being struck in the face by a customer, claimed as psyche/nervous system injury) and a cumulative trauma injury ending November 20, 2018 (orthopedic injuries to spine, shoulders, wrist, and knees). The WCJ found industrial injury in both cases to the lumbar spine, cervical spine, right shoulder, right wrist, and knees, even though those orthopedic body parts were only alleged in the cumulative case and the applicant claimed only psyche injury in the specific case. The WCJ rejected QME orthopedist Dr. Sobeck's findings on the erroneous basis that he improperly determined injury rather than disability, and made no findings on the alleged psyche injury. The Board granted reconsideration, finding the WCJ's decision was not supported by substantial evidence, and rescinded and remanded for further development of the record. The Board emphasized that Dr. Haronian's reports did not support a specific orthopedic injury from being hit in the face, and that Dr. Sobeck's role under Labor Code section 4060(c) was precisely to opine on compensability.

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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