Martinez v. Pacific Coast Construction
Timeline
2023
Mar 14
Thursday
Work Injury — Fall from Scaffold
Injury
14-foot fall at Pacific Coast Construction job site, Port of Long Beach. L3-L4 herniated disc, right shoulder impingement syndrome. Ambulance transport to Cedars-Sinai Long Beach.
Location
Port of Long Beach, Pier J
Injury Type
Industrial — fall hazard
Witnesses
Carlos Vega, site foreman
Time
Approx. 09:15 AM
Mar 14Same day
Emergency Room — Cedars-Sinai Long Beach
Medical
C-spine, L-spine, shoulder X-rays. L3-L4 disc herniation confirmed on CT. Right rotator cuff impingement suspected. Prescribed Naproxen, referred to orthopedics.
Treating Physician
Dr. J. Park, ER Medicine
Dx
L3-L4 disc herniation, R. shoulder impingement
Mar 15Fri
DWC-1 Claim Form Filed
Filing
Workers' compensation claim filed. Zurich American acknowledged receipt. Claim accepted.
Apr 2Sun
First PTP Appointment — Dr. Ramirez
Medical
Primary Treating Physician. L3-L4 herniation confirmed, conservative treatment initiated. Physical therapy 3×/week, NSAID continuation. Right shoulder secondary diagnosis.
Provider
Dr. Manuel Ramirez, MD
Work Status
TTD — off work
Apr 10Sat
TTD Payments Commenced
Admin
Temporary Total Disability payments initiated by Zurich at $1,842.31/week based on pre-injury average weekly earnings of $2,763.46.
Jun 15Thu
MRI Lumbar Spine
Medical
L3-L4 severe disc herniation with moderate bilateral foraminal stenosis. Right-sided neural foraminal narrowing at L4-L5. No fracture.
Findings
L3-L4 disc herniation, moderate stenosis
Radiologist
Dr. Y. Tanaka, MD
Aug 22Tue
RFA — L3-L4 Microdiscectomy Filed
Filing
Request for Authorization filed by Dr. Ramirez for L3-L4 microdiscectomy based on MRI findings and failure of 4+ months conservative treatment.
Sep 10Sun
Utilization Review Denial — Surgery
UR Denial
Zurich UR denied L3-L4 discectomy. Stated: "ODG criteria for surgical authorization not met; insufficient documentation of failed conservative treatment." Appealed via IMR.
Oct 15Sun
TTD Closed — Modified Duty Return
Admin
Claimant cleared for limited modified duty by Dr. Ramirez. TTD payments closed after 27 weeks, totaling $49,742.37.
Nov 30Thu
QME Panel — Dr. Anil Singh Appointed (Mutual)
Admin
Parties agreed on Dr. Anil Singh, MD as AME (Agreed Medical Examiner), orthopedics. Examination scheduled for January 2024.
2024
Jan 8Mon
QME Examination — Dr. Anil Singh, MD
Medical
4-hour comprehensive orthopedic examination. Range of motion testing, functional assessment, records review. Raw WPI per AMA Guides 5th Ed.
Duration
4 hours
Raw WPI
22% (pre-surgery)
Feb 15Thu
QME Report Received — Dr. Singh
Medical
22% WPI lumbar, 8% WPI right shoulder. MMI not reached — surgical intervention recommended prior to final rating. 30% apportionment to pre-existing per carrier claim.
Lumbar WPI
22% (pre-surgery)
Shoulder WPI
8%
MMI Reached
No — surgery pending
Apportionment
30% pre-existing (disputed)
Mar 1Fri
IMR Decision — UR Denial REVERSED
Authorized
Maximus Federal Services reversed Zurich UR denial. L3-L4 microdiscectomy authorized. Zurich required to authorize and pay for surgery within 5 business days.
Mar 15Fri
MSC Hearing — Continued to May 10
Hearing
Mandatory Settlement Conference, WCAB Long Beach Dept. 4. Case continued — QME addendum on post-surgical impairment pending. Parties in agreement to continue.
Apr 22Mon
L3-L4 Microdiscectomy Performed
Medical
Good Samaritan Hospital, Los Angeles. Dr. Manuel Ramirez, MD — spine surgery. Procedure successful, no intraoperative complications. Post-op recovery initiated.
Facility
Good Samaritan, LA
Surgeon
Dr. Manuel Ramirez, MD
Procedure
L3-L4 microdiscectomy
Outcome
Successful, no complications
May 10Fri
MSC Hearing — Continued to June 10
Hearing
Recovery ongoing; QME addendum not yet available. Case continued to June 10, 2024. Claimant doing well post-surgery.
May 25Sat
Post-Surgical FCE — Dr. Patricia Kim
New
Functional Capacity Evaluation shows significant improvement post-surgery. Preliminary WPI 35% (lumbar + shoulder combined). Full evaluation report uploaded.
Provider
Dr. Patricia Kim, MD
Preliminary WPI
35% combined
May 27Mon
QME Addendum Requested
Pending
Formal request sent to Dr. Anil Singh for post-surgical impairment addendum incorporating FCE results. Expected turnaround: 3–4 weeks.