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Celia Cervantes — ADJ8204680

CELIA CERVANTES, Applicant vs. PACIFIC AMERICAN FISH COMPANY; MAJESTIC INSURANCE COMPANY; TECHNOLOGY INSURANCE COMPANY, administered by AMTRUST NORTH AMERICA, Defendants

ADJ number: ADJ8204680
Decision date: Apr 11, 2021
District office: Marina Del Rey
WCJ: —
Claim administrator: AmTrust North America (administering Technology Insurance Company); Majestic Insurance Company
Commissioners: ANNE SCHMITZ, DEPUTY COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: lumbar spine, cervical spine, right upper extremity, psyche, fibromyalgia, head, jaw

LC §4062.2LC §4062.3LC §4064LC §5703LC §5708LC §5903LC §5904LC §5952CCR §10843CCR §10955CCR §10786

Summary

Applicant Celia Cervantes sustained an admitted industrial injury and filed a Petition to Reopen adding fibromyalgia and other body parts. After several rheumatology QMEs (Drs. Silver and Salick) were legitimately replaced, the current QME (Dr. Freed) requested to review the prior QMEs' reports to evaluate the claimed fibromyalgia. The WCJ found those prior reports inadmissible and barred them from being sent to Dr. Freed. The Appeals Board granted reconsideration, holding that the reports were lawfully obtained medical-legal evaluations with no taint of ex parte communication, that they constitute relevant medical records under section 4062.3(a)(2), and that they must be provided to the current QME to ensure his opinion rests on an adequate record. The F&O was rescinded and the matter returned to the trial level.

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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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.