WCPanelIQ
En BancQMEMed-legalDenied

Grace Nunes

GRACE NUNES, Applicant vs. STATE OF CALIFORNIA, DEPT. OF MOTOR VEHICLES, Legally Uninsured; STATE COMPENSATION INSURANCE FUND, Adjusting Agency, Defendants

ADJ number
—
Decision date
Aug 28, 2023
District office
Fresno
WCJ
—
Claim administrator
State Compensation Insurance Fund (adjusting agency for the legally uninsured State of California, Dept. of Motor Vehicles)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, NATALIE PALUGYAI, COMMISSIONER

Injury / body parts: cervical spine, left shoulder, right elbow/shoulder, wrist (carpal tunnel syndrome)

LC §115LC §139.2LC §3202.5LC §4061LC §4061.5LC §4062.3LC §4064LC §4060LC §4061LC §4628LC §4660LC §4662LC §4663LC §4664LC §4628LC §5313LC §5705LC §5813LC §5900LC §5902LC §5903LC §5952CCR §9785CCR §10133.36CCR §10341CCR §10421CCR §10682CCR §10683

Summary

In this en banc decision, applicant Grace Nunes sought reconsideration of the Appeals Board's June 22, 2023 en banc Opinion, which had rescinded the WCJ's Findings of Fact and Award and returned the matter to the trial level for development of the record. The June 22 Opinion held that Labor Code section 4663 requires a reporting physician to make the apportionment determination, that there is no statutory provision for 'vocational apportionment,' and that vocational evidence must address (not substitute for) otherwise valid medical apportionment. Applicant argued the QME's apportionment was speculative, that vocational experts could offer a competing causation/apportionment approach, and that the decision would create 'pass-through' apportionment and litigation chaos. The Board rejected these arguments, reaffirmed that only evaluating physicians may render apportionment opinions, and confirmed physicians are well-equipped to assess vocational evidence. The Board denied reconsideration, noting applicant never challenged the core finding that the record failed to comply with section 5313 and Hamilton.

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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