Martinez v. Pacific Coast Construction
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Updated 4 min ago
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Providers
3 of record
Dr. Angela Martinez
Primary Treating Physician · Orthopedics
PTP
WPI
22%
MMI Jan 15
Dr. James Wu
Qualified Medical Evaluator · Orthopedics
QME
WPI
45%
MMI Mar 8
Dr. Patricia Singh
Agreed Medical Evaluator · Pain Management
AME
WPI
35%
MMI Apr 2
Restrictions (current)
·Sedentary work only
·No lifting > 10 lbs
·No prolonged standing or walking
·No repetitive bending or twisting
Provider Opinion Matrix
All providers of record · AI-extracted from source reports
|
Dr. Angela Martinez
PTP · Orthopedics
|
Dr. James Wu
QME · Orthopedics
|
Dr. Patricia Singh
AME · Pain Management
|
|
|---|---|---|---|
| Report Date | Nov 14, 2023 | Mar 8, 2024 | Apr 2, 2024 |
| MMI Date | Jan 15, 2024 | Mar 8, 2024 | Apr 2, 2024 |
| WPI Rating | 22% | 45% | 35% |
| DRE Category | Lumbar Category II | Lumbar Category IV | Lumbar Category III |
| Causation | 100% industrial | 100% industrial | 85% industrial |
| Apportionment | None | None | 15% pre-existing |
| Work Status | Sedentary only | Sedentary only | Modified duty |
| Surgery Rec. | Not recommended | L4–L5 ACDF | Conservative care first |
AI Analysis
Under CA Labor Code §4628(b), the AME's opinion (Dr. Singh, 35% WPI) is generally controlling where parties agreed to an AME panel. The 23-point spread between PTP (22%) and QME (45%) opinions elevates dispute risk significantly. Dr. Singh's 15% apportionment to pre-existing condition will reduce the final PD award. Confirm AME agreement status before proceeding to MSC.
Dr. Wu QME 3/8/24
Dr. Singh AME 4/2/24
CA LC §4628(b)
Confirmed Diagnoses
ICD-10 codes extracted from provider reports
M51.16
L4–L5 Intervertebral Disc Degeneration with Radiculopathy
MRI 2/12/24
QME 3/8/24
M54.5
Lumbar Strain / Chronic Low Back Pain
PTP 11/14/23
S80.01XA
Right Knee Contusion
PTP 8/14/23
AI Analysis
The L4–L5 disc herniation (M51.16) is the primary compensable injury and the basis for the permanent disability dispute. The right knee contusion resolved without permanent impairment. No additional diagnoses were raised by any provider. The QME's DRE Lumbar Category IV classification (vs. PTP's Category II) is the root cause of the WPI conflict.
Dr. A. Martinez PTP 11/14/23
Dr. Wu QME 3/8/24
Treatment History
Chronological record · Mar 2023 – present
Mar 25, 2023
Initial evaluation — Dr. Angela Martinez, PTP
Orthopedic examination, diagnosis of lumbar strain and right knee contusion. Work status: TTD.
Mar 25 –
Aug 14, 2023
Aug 14, 2023
Physical therapy — 47 sessions
2× per week at Pacific Coast PT. Hot/cold, therapeutic exercise, manual therapy. Limited functional improvement noted at 6-month reassessment.
May 12, 2023
Epidural steroid injection — L4–L5
Fluoroscopic-guided injection at Pacific Interventional Pain. Temporary relief reported for 3–4 weeks.
Jul 21, 2023
Second epidural steroid injection — L4–L5
Repeat injection with shorter duration of relief. Surgeon consultation ordered.
Aug 14, 2023
Right knee: full resolution
Knee contusion fully resolved, removed from active diagnosis list.
Oct 3, 2023
MRI lumbar spine — ordered
Ordered by Dr. Martinez due to inadequate response to conservative care. UR approved 10/12/23.
Nov 14, 2023
PTP Progress Report — Dr. Angela Martinez
Work status: TTD continuing. MMI opinion: Jan 15, 2024. WPI: 22% DRE Category II.
Feb 12, 2024
MRI completed — Pacific Imaging Group
L4–L5 disc herniation with moderate right foraminal stenosis and L5 nerve root compression confirmed.
Mar 8, 2024
QME evaluation — Dr. James Wu
Independent orthopedic evaluation. WPI: 45% DRE Category IV. Surgery recommendation: L4–L5 ACDF.
Apr 2, 2024
AME evaluation — Dr. Patricia Singh
Pain management evaluation. WPI: 35% DRE Category III. Apportionment: 15% pre-existing. Conservative treatment recommended before surgery.