CSAA; TRAVELERS INSURANCE COMPANY, DAVID KELLER, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIADAVID KELLER, Applicant,vs.CSAA; TRAVELERS INSURANCE COMPANY, Defendant(s).Case No. ADJ2940818 (STK 0138641)OPINION AND ORDER DENYING RECONSIDERATION Defendant seeks reconsideration of the Findings and Award issued by a workers’ compensation administrative law judge (WCJ) on September 29, 2009, wherein the WCJ found, that pursuant to parties’ stipulations set forth in the October 14, 2008 Minutes of Hearing, that applicant sustained industrial injury to his neck and left shoulder as a result of cumulative trauma through July 11, 1997, and that applicant was awarded permanent disability of eight percent and further medical care. The WCJ also found that applicant’s entitlement to further medical care included his entitlement to a gym membership and to an inversion table, but not to a Ceragem bed. In its Petition for Reconsideration, defendant contends that the WCJ erred in awarding applicant a gym membership and an inversion table where these modalities are not specifically covered by evidence-based medicine. With respect to the gym membership, defendant argues that the opinions of applicant’s treating physician, Patrick Rhoades, M.D., and that of applicant’s Qualified Medical Evaluator (QMIE), David L. Kneapler, M.D., do not constitute substantial evidence to support the WCJ’s decision. Defendant contends that the WCJ erred in disregarding the report of Robert Simpson, M.D., its Utilization Review (UR) physician, which is the only opinion based on more than applicant’s self-reported helpfulness of his nine years of gym , membership. Defendant argues that discounting the UR physician’s opinion because he or she has not interviewed or examined applicant is not what was contemplated by the 2004 Reform legislation and emasculates the UR process (which is essentially defendant’s only remedy to challenge a treatment request) and the requirement fo
David Keller, vs. Csaa; Travelers Insurance Company,
(STK 0138641)This case is about David Keller, who was awarded permanent disability of eight percent and further medical care after sustaining an industrial injury to his neck and left shoulder as a result of cumulative trauma through July 11, 1997. The defendant, CSAA; Travelers Insurance Company, sought reconsideration of the Findings and Award, arguing that the WCJ erred in awarding applicant a gym membership and an inversion table where these modalities are not specifically covered by evidence-based medicine. The WCJ's decision was supported by the record and the defendant's Petition for Reconsideration was denied.
- Filed On:
- Court: California, Stockton
- Case No. ADJ2940818
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