WCPanelIQ
PanelQMEMed-legalLienGranted

Torres, Berenice

BERENICE TORRES, Applicant vs. WALMART INC; ACE AMERICAN INSURANCE COMPANY; ADMINISTERED BY SEDGWICK, Defendants

ADJ number
ADJ13523690
Decision date
Jun 5, 2025
District office
Van Nuys
WCJ
—
Claim administrator
Sedgwick (administering for ACE American Insurance Company)
Commissioners
CRAIG SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: head, ear, eye, back, right lower extremity, psyche, hair loss, COVID-19, legs, chest, respiratory system

LC §5909LC §5900LC §5950LC §3212LC §3213LC §3212.86LC §3212.87LC §3212.88LC §3202.5LC §5705LC §5313LC §5907LC §5908LC §5908.5LC §5803LC §5901LC §4600CCR §10600CCR §9785

Summary

Lien claimant Medland Medical petitioned for reconsideration of a WCJ's Joint Findings and Award that found applicant Berenice Torres did not sustain industrial injury (AOE/COE) in either a specific (July 20, 2020, including COVID-19) or cumulative trauma claim, and that the lien claimant failed to prove entitlement to treatment reimbursement except for one medical-legal evaluation dated September 21, 2020. The petitioner argued the WCJ erred in relying on the PQME reports rather than the treating physician's medical-legal reporting. The Appeals Board granted reconsideration, noting that the record contained no evidence of whether an outbreak occurred at applicant's specific place of employment, making it impossible to determine whether the COVID-19 presumption under Labor Code section 3212.88 applies, raising due process concerns. The Board deferred a final decision after reconsideration pending further review of the merits and the entire record.

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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