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Ping Hung Li — ADJ14149688, ADJ21878559

PING HUNG LI, Applicant vs. MODERN CONSTRUCTION, INC.; FALLS LAKE FIRE AND CASUALTY COMPANY, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants

ADJ number
ADJ14149688, ADJ21878559
Decision date
Jul 26, 2026
District office
San Francisco
WCJ
—
Claim administrator
Sedgwick Claims Management Services, Inc. (administering for Falls Lake Fire and Casualty Company)
Commissioners
PAUL F. KELLY, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, CRAIG L. SNELLINGS, COMMISSIONER

Injury / body parts: cervical spine, lumbar spine, right shoulder, right clavicle, excretory system, bilateral upper extremities, bilateral lower extremities, neck

LC §5900LC §5903LC §5906LC §5909LC §5952LC §5701CCR §9785CCR §9811CCR §10600CCR §10964

Summary

In this consolidated case, defendant sought reconsideration of a WCJ's Joint Findings, Award, and Orders that found industrial injury to the cervical and lumbar spine with 44% permanent disability. The dispute centered on whether QME Dr. Chen's revised opinions—which reduced spinal impairment to 0% based on surveillance video via an Almaraz/Guzman analysis, set MMI at or before March 6, 2021, and cut off future medical treatment—constituted substantial medical evidence. The WCAB granted reconsideration and rescinded the F&A, finding that none of the QME reporting relied upon was substantial medical evidence, whether the original stale reports or the post-surveillance reports. The Board held Dr. Chen's Almaraz II analysis was conclusory, that the March 6, 2021 surveillance had been ruled unauthenticated and should never have been sent to the QME, that the MMI finding was speculative given post-2021 surgery, and that the treatment cutoff amounted to impermissible apportionment of medical treatment. The matter was returned to the WCJ to develop the record, potentially with a new evaluator.

Issues

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Holding

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