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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ4047184 (RDG 0115958)
Regular
Dec 02, 2009

BRICE SANDHAGEN vs. STATE COMPENSATION INSURANCE FUND

The court affirmed the WCJ's decision that the defendant was barred from relying on the utilization review process due to missed deadlines. The UR process is the employer's only avenue for resolving treatment requests.

RemittiturUtilization ReviewLabor Code section 4610(g)(1)Labor Code section 4062(a)Treating Physician RecommendationWCJFindings and Award and OrderPetition for ReconsiderationEn Banc DecisionCourt of Appeal
References
5
Case No. RDG 0115958
En Banc
Nov 16, 2004

Brice Sandhagen vs. Cox & Cox Construction, Inc.; State Compensation Insurance Fund

The Appeals Board held that utilization review time deadlines under Labor Code section 4610(g)(1) are mandatory. A defendant's failure to comply precludes the use of the utilization review process, renders the resulting report inadmissible, and requires the defendant, as the objecting party, to follow the dispute resolution procedures of section 4062(a).

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610(g)(1)Mandatory DeadlinesAdmissibility of EvidenceACOEM GuidelinesTreating PhysicianMedical Treatment RecommendationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)
References
23
Case No. MISSING
En Banc
Feb 07, 2005

Brice Sandhagen vs. Cox & Cox Construction, Inc.; State Compensation Insurance Fund

The Appeals Board dismisses the applicant's petition for reconsideration, finding it premature because it was filed in response to an interlocutory order that remanded the case for further proceedings, rather than a final decision.

Labor Code 4610Labor Code 4062(a)Utilization ReviewQME/AMEPetition for ReconsiderationFinal OrderInterlocutory OrderRescinded DecisionRemanded MatterMandatory Deadlines
References
36
Case No. RDG 0115958
Significant
Nov 16, 2004

Brice Sandhagen, Applicant vs. Cox & Cox Construction, Inc.; State Compensation Insurance Fund

The Appeals Board held that the utilization review time deadlines are mandatory; if a defendant fails to meet these deadlines, any utilization review report is inadmissible, and the defendant must use the AME/QME procedure as the objecting party.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610Time DeadlinesAdmissibility of EvidenceMedical Treatment RecommendationACOEM GuidelinesAgreed Medical EvaluatorQualified Medical EvaluatorSection 4062
References
23
Case No. RDG 0115958
Significant

Brice Sandhagen, Applicant vs. Cox & Cox Construction, Inc., State Compensation Insurance Fund

The Board dismisses the applicant's petition for reconsideration because it was made from an interlocutory (non-final) order, as the matter had been remanded to a WCJ for further proceedings. The Board also observes that utilization review is not a mandatory prerequisite for a defendant to use the QME/AME process.

WORKERS' COMPENSATION APPEALS BOARDEN BANCOPINION AND ORDER DISMISSING PETITION FOR RECONSIDERATIONBrice SandhagenCox & Cox ConstructionInc.State Compensation Insurance FundLabor Code section 4610(g)(1)utilization reviewWCJ
References
39
Case No. 3-93-329-CV
Regular Panel Decision
Jun 15, 1994

Texas Workers' Compensation Insurance Facility v. the Aberdeen Group, Inc. Wallace Brumley And Douglas A. Brice

The Texas Workers' Compensation Insurance Facility appealed the trial court's order terminating an ex parte receivership it had obtained over The Aberdeen Group, Inc. The Facility brought ten points of error, challenging the trial court's conclusions on standing, mootness, evidentiary sufficiency, and due process. The Court of Appeals reviewed the trial court's actions, findings of fact, and conclusions of law. The court found that the Facility did have standing and disagreed with the mootness argument, and it overruled the evidentiary points due to multifariousness. The court also concluded that the Facility was afforded due process. Ultimately, the Court of Appeals affirmed the trial court's order.

Receivership TerminationEx Parte ReceivershipAppellate ReviewDue Process RightsStanding IssuesMootness DoctrineSufficiency of EvidenceTrial Court Order AffirmedTexas Court of AppealsCivil Procedure
References
15
Case No. ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667) ADJ2270309 (VNO 0113668)
Regular
May 18, 2009

MARIA GARCIA vs. CITY OF LOS ANGELES

The Appeals Board dismissed the applicant's petition for reconsideration as it was not from a final order. However, the Board granted removal, rescinded the WCJ's order suspending submission, and returned the case for further proceedings. The WCJ improperly suspended proceedings without statutory authority and failed to resolve issues including utilization review compliance under *Sandhagen*. The Board ordered the WCJ to first address *Sandhagen* issues and proper utilization review before any further medical record development.

Petition for ReconsiderationPetition for RemovalOrders Suspending Submissionsubstantial evidenceutilization reviewuntimelyunsignedpenaltyattorney's feesneglect and delay
References
2
Case No. 02-14-00331-CV
Regular Panel Decision
Dec 23, 2014

Liberty Insurance Company v. W. Brice Cottongame as Personal Representative of the Estate of A.G., and as Next Friend of A.G., I.G., A.G., I.G., and J.G., Individually, F.Z., Individually, M.Z., Individually

Liberty Insurance Company appealed two summary judgments in a workers' compensation subrogation case to the Second District of Texas, Fort Worth. The first judgment, finalized on January 24, 2014, was appealed nine months later, rendering the notice untimely. The second judgment, signed July 7, 2014, was followed by a motion for reconsideration that the appellate court determined did not "assail the judgment" and therefore failed to extend the appellate timetable. As a result, the court found Liberty's October 17, 2014 notice of appeal untimely for both judgments. The Appellees' motions to dismiss the appeal for want of jurisdiction were granted.

JurisdictionUntimely AppealSummary JudgmentWorkers' CompensationSubrogation ClaimsMotion to Extend TimeAppellate TimetableMotion to ReconsiderPlea to the JurisdictionDismissal of Appeal
References
8
Case No. ADJ2738569 (LAO 0759524) ADJ553488 (LAO 0759510)
Regular
Oct 29, 2010

CONNIE ALVIZO vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, Permissibly Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding the applicant's entitlement to 24/7 home health care. The Board adopted the WCJ's report and emphasized that the defendant failed to submit the primary treating physician's request for this care to mandatory utilization review. Citing *Sandhagen*, the Board affirmed that Labor Code § 4610 utilization review is the sole mechanism to challenge medical treatment requests. Therefore, the defendant's failure to follow this process bars their current challenge to the 24/7 home health care.

Workers' Compensation Appeals BoardConnie AlvizoDepartment of Industrial RelationsPermissibly UninsuredState Compensation Insurance FundPetition for ReconsiderationFindings and Orderhome health care24 hour/7 days per weeksenior legal stenographer
References
1
Case No. ADJ888182 (PAS 0004570)
Regular
Jan 20, 2009

LUCRECIA TEJEDA vs. FELLINI'S RESTAURANT, FARMERS INSURANCE

The Appeals Board rescinded the WCJ's decision denying spinal surgery and returned the case for further proceedings, finding the defendant failed to conduct mandatory Utilization Review (UR) after a treating physician recommended surgery. The Board emphasized that per *Sandhagen* and *Cervantes*, defendants must follow strict UR and objection timelines for surgical requests. The WCJ was also directed to revisit the applicant's claims for medical mileage and penalties for non-payment of bills, as these issues were improperly deferred. The case will be decided anew by the WCJ, applying current legal standards.

Workers' Compensation Appeals BoardReconsiderationSpinal SurgeryUtilization ReviewLabor Code Section 4062(b)Agreed Medical EvaluatorTreating PhysicianDepositionPermanent DisabilityMedical Mileage
References
3
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