Martinez v. Pacific Coast Construction

Case Overview

Client Guidelines Opening report due within 15 days Budget required before litigation Only approved panel attorneys may bill Use approved court reporter for depositions CC Zurich on all outbound correspondence
Case Facts
Claimant Eduardo Martinez
DOB Jun 15, 1978 (45)
Employer Pacific Coast
Construction, Inc.
Carrier Zurich American
Insurance
Injury L3-L4 Disc Herniation,
R. Shoulder Impingement
DOI Mar 14, 2023
Jurisdiction CA WCAB · Long Beach
QME Dr. Anil Singh, MD
AME Orthopedics
Open Issues 5 of 6 active
Issue Status Evidence
Permanent Disability (PD Rating)
Awaiting QME addendum — final PD % not established
Pending QME
QME Report
MMI Determination
Post-surgery; MMI expected Q3 2024
Open
FCE Report
Apportionment Analysis
Carrier claims 30% pre-existing condition
Disputed
2 docs
Vocational Rehabilitation
Eligibility assessment pending MMI
Pending MMI
—
Temporary Total Disability (TTD)
Paid Apr 10 – Oct 14, 2023 @ $1,842.31/wk
Resolved
Pay records
Surgery Authorization — L3-L4 Discectomy
IMR reversal 03/01/2024; surgery completed 04/22/2024
Resolved
IMR Decision
Upcoming Deadlines 3 pending
May 31
Carrier Demand Response
Reply to Zurich apportionment demand
Jun 10
MSC Hearing
WCAB Long Beach — Dept. 4
Jun 30
PD Rating Deadline
Final rating due post-QME addendum
Activity
Post-Surgical FCE Report uploaded
Dr. Patricia Kim, MD — Functional Capacity Evaluation post L3-L4 microdiscectomy. Preliminary WPI: 35%.
Medical View document
May 25
Conflict detected: PD rating discrepancy
QME (Dr. Singh) reports 22% WPI vs. PTP (Dr. Ramirez) reports 45% WPI. Requires attorney review.
Conflict
May 25
QME Addendum requested
Request sent to Dr. Anil Singh for post-surgical impairment addendum. Expected: 3–4 weeks.
Admin
May 27
Carrier demand letter received
Zurich American — demand re: apportionment, claims 30% pre-existing. Response due May 31, 2024.
Correspondence Due May 31
May 20
MSC Hearing — continued to June 10
WCAB Long Beach. Continued from May 10 — post-surgical recovery ongoing, QME addendum pending.
Hearing
May 10
L3-L4 Microdiscectomy completed
Good Samaritan Hospital, Los Angeles. Dr. Manuel Ramirez — operative report uploaded.
Medical
Apr 22
Case Contacts
SC
Sarah Chen, Esq.
Attorney of Record
AS
Dr. Anil Singh, MD
AME Orthopedics
LT
Lisa Torres
Zurich — Claim Adjuster