WCPanelIQ
PanelQMEMed-legalDenied

Hailey, Darren

DARREN HAILEY, Applicant vs. CONTINENTAL LABOR; NATIONAL UNION FIRE INSURANCE COMPANY, Administered by GALLAGHER BASSETT SERVICES, INC., Defendants

ADJ number
ADJ11207109
Decision date
May 28, 2025
District office
Bakersfield
WCJ
—
Claim administrator
Gallagher Bassett Services, Inc. (administering for National Union Fire Insurance Company)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: left knee, right knee, lumbar spine, right wrist

LC §4663LC §3202.5

Summary

Applicant Darren Hailey, a crane operator, sustained two industrial injuries (October 20, 2017 and December 1, 2017) to his left knee, lumbar spine, right knee, and right wrist. The QME, Dr. Kenly, apportioned 50 percent of applicant's permanent disability to preexisting nonindustrial morbid obesity. Applicant sought reconsideration arguing the QME's apportionment opinion was based on speculation and conjecture and did not constitute substantial medical evidence. The majority affirmed both Findings and Awards, holding the QME adequately explained the basis for his apportionment determination under Section 4663 and Escobedo/Gatten. Chair Zalewski dissented, arguing the QME identified obesity as a factor but failed to explain how he arrived at the specific 50 percent figure, rendering the apportionment analysis incomplete and not substantial evidence.

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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