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PanelQMEMed-legalDenied

Luva Wilson — ADJ11914024

LUVA WILSON, Applicant vs. BLUE SHIELD OF CALIFORNIA; ARCH INSURANCE administered by SEDGWICK, Defendants

ADJ number
ADJ11914024
Decision date
Apr 12, 2021
District office
Pomona
WCJ
Charles Bentley
Claim administrator
Sedgwick (administering for Arch Insurance)
Commissioners
—

Injury / body parts: left elbow, left wrist, back, neck, bilateral legs, stress and anxiety (psyche)

LC §5705LC §3202.5LC §3600

Summary

Applicant Luva Wilson, a 44-year-old claims examiner, alleged a cumulative trauma injury (June 1, 2018 through February 1, 2019) to multiple body parts, which defendant denied. PQME Dr. Charles Schwarz examined applicant and issued an initial report plus three supplemental reports, ultimately concluding the injuries were non-industrial based on longstanding pre-existing conditions, a short employment period, and applicant's job duties. The WCJ found Dr. Schwarz's reporting constituted substantial medical evidence and that applicant failed to meet her burden of proving AOE/COE. Applicant's only argument on reconsideration was that she should be permitted to depose the PQME, but she had never scheduled or attempted a deposition and offered no evidence rebutting the reports. The WCAB adopted and incorporated the WCJ's report and denied reconsideration, finding applicant did not exercise due diligence in developing the record before trial and her request to do so was untimely.

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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