WCPanelIQ
PanelQMEMed-legalDenied

Maria Castaneda — ADJ9334882

MARIA CASTANEDA, Applicant vs. ARAMARK; ACE AMERICAN INSURANCE COMPANY, administered by SEDGWICK CMS, Defendants

ADJ number
ADJ9334882
Decision date
Apr 15, 2021
District office
San Diego
WCJ
—
Claim administrator
Sedgwick CMS (administering for ACE American Insurance Company)
Commissioners
DEIDRA E. LOWE, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: left shoulder, bilateral wrists, bilateral hands

LC §4600LC §3207LC §5814LC §5705CCR §10507CCR §10605

Summary

Maria Castaneda claimed injury to her bilateral wrists and left shoulder while working as a custodian/housekeeper for Aramark. Defendant initially authorized left shoulder treatment, including surgery, but withdrew authorization and denied the left shoulder claim after the replacement QME, Dr. Stephen Banes, opined the left shoulder condition was not industrially related. The WCJ originally found injury to the left shoulder, a need for treatment, and awarded penalties under section 5814 for unreasonable denial. On reconsideration, the Appeals Board struck the penalty award, finding the denial was not unreasonable. Applicant sought further reconsideration, but the Board affirmed, holding that Dr. Banes' report created a genuine doubt as to liability that made defendant's delay reasonable.

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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