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Martin Perez — ADJ13594888

MARTIN PEREZ, Applicant vs. HARRIS REBAR; BITCO INS. / OLD REPUBLIC GENERAL INSURANCE CORPORATION, administered by GALLAGHER BASSETT, Defendants

ADJ number
ADJ13594888
Decision date
Apr 12, 2026
District office
San Jose
WCJ
Ironworkers Workers' Compensation Alternative Dispute Resolution Program Arbitrator (WCA)
Claim administrator
Gallagher Bassett Services (administering for BITCO Insurance / Old Republic General Insurance Corporation / CIG; also Zurich Insurance Company)
Commissioners
JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: cervical spine, thoracic spine, lumbar spine, bilateral shoulders, bilateral upper extremities, bilateral hands, bilateral wrists, bilateral knees, bilateral feet, bilateral ankles, psyche

LC §4660.1LC §4662LC §4663LC §4664LC §4659LC §4751LC §5272LC §5313LC §5900LC §5903LC §5909LC §5952LC §5412CCR §10600CCR §10682

Summary

Martin Perez, an ironworker, sustained a cumulative trauma injury through October 1, 2017 to multiple body parts including his psyche. An arbitrator under the Ironworkers WC carve-out ADR program found 94% PPD without apportionment, but rejected applicant's claim of permanent total disability, in part by employing a 'range of evidence' approach and relying on the arbitrator's own interpretation of sub rosa video. The WCAB granted reconsideration, finding the arbitrator improperly used a 'range of evidence' approach where neither QME report constituted substantial evidence and improperly injected his own lay opinion of impairment based on surveillance video. The Board held applicant proved permanent total disability in accordance with the fact under Labor Code section 4662 based on Dr. Henry's substantial work restrictions and Mr. Simon's vocational analysis, and that section 4660.1(c)'s psyche exclusion does not apply to PTD findings under section 4662. The majority rescinded the Third Amended F&A and substituted a finding of 100% PTD, also admitting Defendant's Exhibit E. Commissioner Razo dissented, arguing the record lacked substantial medical evidence and should be remanded for a functional capacity evaluation.

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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