WCPanelIQ
PanelQMEMed-legalGranted

Pedroza, Ruben

RUBEN PEDROZA, Applicant vs. OC JONES & SONS, INC.; NATIONAL UNION FIRE INSURANCE CO., administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants

ADJ number
ADJ15306840
Decision date
May 26, 2025
District office
Oakland
WCJ
—
Claim administrator
Sedgwick Claims Management Services, Inc. (administering National Union Fire Insurance Co.)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: right shoulder, back, neck

LC §5909LC §5900LC §5313LC §5705LC §3202.5LC §3600LC §5903LC §5952LC §5905CCR §10600CCR §10940CCR §10402CCR §10787CCR §41.5CCR §41.6

Summary

Applicant Ruben Pedroza claimed an industrial right shoulder injury while working as a construction laborer on September 24, 2021. The WCJ found the facts and medical evidence irreconcilable, found no substantial medical evidence of industrial injury, and ordered applicant to take nothing. Applicant sought reconsideration arguing the QME's reporting constituted substantial medical evidence and that the WCJ improperly relied on the QME's summary of subrosa video that was never admitted into evidence. The Board granted reconsideration, holding that subrosa video used to attack credibility must be admitted in evidence and reviewed by the judge, and that the QME's description of the video actually corroborated applicant's history rather than impeaching it. The Board also identified a potential disqualifying conflict of interest because QME Dr. Centeno appeared to share a practice with applicant's primary treating physician, Dr. Nissen, under AD Rule 41.5. The Board rescinded the F&O and returned the matter to the trial level for further development of the record.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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