WCPanelIQ
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Aviles, Zenaida

ZENAIDA AVILES, Applicant vs. PIH HEALTH HOSPITAL, permissibly self-insured; administered by ATHENS ADMINISTRATORS., Defendants

ADJ number
ADJ10908652
Decision date
Sep 15, 2025
District office
Los Angeles
WCJ
—
Claim administrator
Athens Administrators (administering for PIH Health Hospital, permissibly self-insured)
Commissioners
JOSEPH V. CAPURRO, COMMISSIONER, LISA A. SUSSMAN, DEPUTY COMMISSIONER, PAUL F. KELLY, COMMISSIONER

Injury / body parts: psyche, lumbar spine, right leg, right foot, right ankle

LC §3208.3LC §4660.1LC §5313LC §5412LC §5500.5LC §5900LC §5903LC §5909LC §5952

Summary

Applicant Zenaida Aviles sought reconsideration of a Joint Findings and Award that found no industrial psychiatric injury on a cumulative basis, found a specific psychiatric injury, but barred psychiatric permanent disability under Labor Code section 4660.1. The WCAB granted reconsideration, finding the WCJ misread the psychiatric QME's reports, which actually concluded applicant did sustain a cumulative trauma psychiatric injury, and that no finding had issued on the date of injury under section 5412. The Board found the medical record was not substantial evidence because Dr. Maloff's opinion that the psychological disability was 'inextricably intertwined' between the two injuries was conclusory and lacked adequate explanation. The Board also clarified errors in the WCJ's catastrophic injury analysis under Wilson but declined to reach the issue pending development of the record. The F&A was rescinded and the matter returned to the trial level for further proceedings.

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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