WCPanelIQ
PanelMed-legalLienGranted

Sanchez, Esmeralda

ESMERALDA SANCHEZ, Applicant vs. KELLERMEYER BERGENSONS SERVICES, LLC; CONSTITUTION STATE SERVICES; ZURICH AMERICAN INSURANCE COMPANY, Defendants

ADJ number
ADJ18189986
Decision date
May 4, 2025
District office
Van Nuys
WCJ
—
Claim administrator
Constitution State Services; Zurich American Insurance Company
Commissioners
CRAIG SNELLINGS, COMMISSIONER, JOSE H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: knees, feet, trunk, both shoulders, lumbar spine

LC §139.2LC §4600LC §4620LC §4621LC §4628LC §4903LC §5307.6LC §5803LC §5900LC §5901LC §5903LC §5907LC §5908LC §5908.5LC §5909LC §5950LC §5952CCR §9795

Summary

Applicant Esmeralda Sanchez, a janitor, alleged a continuous trauma injury (8/31/2022-8/31/2023) to her knees, feet, trunk, shoulders, and lumbar spine, and the underlying claim was resolved by Compromise and Release approved 3/20/2024. Lien claimant Spectrum Medical Group pursued a $5,131.32 lien for treatment and a medical-legal report by Dr. Nia. The WCJ found Dr. Nia's report inadmissible under Labor Code section 4628 (no interpreter identified, inaccurate/incomplete history, failure to disclose time spent), held the lien claimant failed to prove AOE/COE while standing in applicant's shoes, and awarded only $1,000 for the 10/25/2023 date of service plus penalties and interest. Both defendant and lien claimant sought reconsideration. The Board granted both petitions, finding the record was not properly developed and not supported by substantial evidence, and deferred a final decision pending further review.

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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