WCPanelIQ
PanelQMEMed-legalGranted

Maldonado, Rogelio

ROGELIO MALDONADO, Applicant vs. AL LOWE CONSTRUCTION, INC.; EVEREST NATIONAL INSURANCE COMPANY, administered by AMERICAN CLAIMS MANAGEMENT, INC., Defendants

ADJ number
ADJ11198598
Decision date
Sep 1, 2025
District office
Oxnard
WCJ
—
Claim administrator
American Claims Management, Inc. (administering for Everest National Insurance Company)
Commissioners
JOSEPH V. CAPURRO, COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER

Injury / body parts: left knee, low back, right knee

LC §5909LC §5900LC §5950LC §5903LC §4664LC §5803LC §5804LC §5410LC §5313LC §5907LC §5908LC §5908.5LC §5901CCR §10600

Summary

Applicant Rogelio Maldonado, a laborer, sustained an industrial injury to his left knee and low back on February 20, 2017, which previously settled by Stipulated Award at 42 percent permanent partial disability. He filed a Petition to Reopen for New and Further Disability, which the WCJ denied, finding no increased disability after applying the QME's apportionment of his current condition (75% to the 2017 injury and 25% as a sequela of a separate 2020 right knee injury). The Board accepted the petition as timely (filed within 20 days of actual receipt of the F&O on June 10, 2025) and granted reconsideration. The Board questioned whether the QME applied a correct legal theory of apportionment, particularly in light of the conclusive presumption of prior disability under Labor Code section 4664(b) and the Vargas en banc decision. The Board granted the petition, deferred a final decision on the merits, and ordered the matter set for a status conference for further development of the record.

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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