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PanelQMEMed-legalDenied

Zamora, Antonio

ANTONIO ZAMORA, Applicant vs. AT&T COMMUNICATIONS; OLD REPUBLIC INSURANCE, administered by SEDGWICK CMS., Defendants

ADJ number: ADJ12975722
Decision date: Sep 4, 2025
District office: Van Nuys
WCJ: —
Claim administrator: Sedgwick CMS (administering for Old Republic Insurance)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, CRAIG SNELLINGS, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: right hip, hypertension, diabetes, right shoulder, lumbar spine, left shoulder, lower extremities

LC §5909LC §5900LC §5705LC §5903LC §5952CCR §10803CCR §10600

Summary

Applicant Antonio Zamora sustained a cumulative injury (May 13, 2015 through May 13, 2016) and a specific injury on February 4, 2020. The May 15, 2025 Joint F&A found new and further disability to the right hip, hypertension, and diabetes in the cumulative claim (increasing PD from 57% to 70%) and a separate 28% PD to the right shoulder for the specific injury. Defendant sought reconsideration, arguing the WCJ should have relied on prior AME Dr. Berman over replacement AME Dr. Heskiaoff for orthopedic findings, and that internal PQME Dr. Lonky's reporting required allocating increased hypertension/diabetes impairment to the 2020 specific injury rather than the cumulative injury. The Board denied reconsideration, finding Dr. Heskiaoff's reports constituted substantial evidence and that defendant failed to meet its burden of proof on apportionment because Dr. Lonky's apportionment opinions were vague, unreasoned, and speculative under Escobedo and Gatten.

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.