PanelQMEGranted in Part
Fishel, Michael
MICHAEL FISHEL, Applicant vs. RICK’S LUBE AND COMPLETE AUTO; OAK RIVER INSURANCE COMPANY, administered by BERKSHIRE HATHAWAY HOMESTATE COMPANIES, Defendants
- ADJ number
- ADJ11053430
- Decision date
- Jun 22, 2025
- District office
- Santa Ana
- WCJ
- —
- Claim administrator
- Berkshire Hathaway Homestate Companies (administering for Oak River Insurance Company)
- Commissioners
- JOSEPH V. CAPURRO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER
Injury / body parts: lumbar spine, back, hips, leg, nervous system, excretory system
LC §5701LC §5909LC §5900LC §5902LC §5903LC §5904LC §5952LC §3600LC §4600LC §5705LC §3202.5LC §3201CCR §10600
Summary
Applicant, an auto mechanic, sustained an August 18, 2017 industrial injury including to his lumbar spine. After PQME Dr. Gumbs repeatedly failed to provide a definitive opinion on the need for lumbar surgery, the WCJ in an April 24, 2023 Order appointed Dr. Laura Hatch as a 'regular physician' under Labor Code section 5701 to bypass the UR/IMR process and address all orthopedic issues, including the proposed surgery. The April 1, 2025 F&A found the parties in compliance with the February 3, 2020 Stipulation and awarded lumbar spine surgery based on Dr. Hatch's opinion. The Board granted reconsideration only to correct Dr. Hatch's appointment date (from April 23 to April 24, 2023) and to clarify that she was to address all orthopedic issues rather than just the surgery, while affirming that UR/IMR had been waived and that Dr. Hatch's reporting constituted substantial medical evidence. The award of lumbar spine surgery was upheld.
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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