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

Case No. ADJ2661083 (AHM 0097587) ADJ2316310 (AHM 0088976)
Regular
Oct 06, 2014

GENEEN RODRIGUEZ vs. STATEK CORPORATION, ACE USA

This case involves defendant Statek Corporation's petition for reconsideration of an award granting applicant Geneen Rodriguez a spinal cord stimulator. The Administrative Law Judge found the utilization review (UR) determination materially defective due to communication issues and the reviewer's specialty. The Appeals Board granted reconsideration, rescinded the award, and found the UR determination was not materially defective. The Board concluded that any alleged defects were not significant enough to bypass the Independent Medical Review (IMR) process.

Utilization ReviewSpinal Cord StimulatorMaterially DefectiveIndependent Medical ReviewLabor Code Section 4610Medical NecessityCompetency of ReviewerInternal MedicineTimely CommunicationDubon v. World Restoration
References
Case No. ADJ4274323 (ANA 0387677), ADJ1601669 (ANA 0388466)
Significant
Feb 27, 2014

Jose Dubon, Applicant vs. World Restoration, Inc. and State Compensation Insurance Fund

The Appeals Board held that disputes over the timeliness and procedural compliance of utilization review (UR) are legal issues for the WCAB to decide, not matters for independent medical review (IMR). A UR decision is invalid if it has material procedural defects, such as failing to review adequate medical records.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewProcedural DefectsMedical NecessityEn Banc DecisionAdministrative Director's RulesSubstantial Medical EvidenceTimelinessMaterial Procedural Defects
References
Case No. ADJ4274323 (ANA 0387677), ADJ1601669 (ANA 0388466)
En Banc
Feb 27, 2014

JOSE DUBON vs. WORLD RESTORATION, INC.; STATE COMPENSATION INSURANCE FUND

The WCAB holds that it has jurisdiction over disputes regarding the procedural validity and timeliness of utilization review (UR) decisions, while Independent Medical Review (IMR) is solely for resolving medical necessity. A UR decision with material procedural defects is invalid, and in such cases, the WCAB, not IMR, will determine the medical necessity of the treatment.

Utilization ReviewIndependent Medical ReviewEn Banc DecisionWCAB JurisdictionProcedural DefectsMedical NecessityLabor Code Section 4610Substantial Medical EvidenceMaterial Procedural DefectsInvalid UR Decision
References
Case No. ADJ9460638
Regular

DAVID HAMALIAN vs. HANSEL FORD, SECURITY NATIONAL INSURANCE CO.

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration regarding a WCJ's order that rescinded a prior finding of no material defect in the defendant's Utilization Review (UR). This decision was based on a subsequent en banc ruling, *Dubon II*, which held that UR decisions are invalid only if untimely. Consequently, the Board rescinded the WCJ's Amended Findings & Order and remanded the case for further proceedings and a new decision consistent with *Dubon II*. The prior finding that the UR was not materially defective was rescinded, and the matter will be reheard to determine the UR's timeliness and applicant's need for surgery.

Utilization ReviewMaterial DefectDubon IDubon IIPetition for ReconsiderationFindings & OrderRescindedAdministrative Law JudgeAppeals BoardEn Banc Decision
References
Case No. ADJ10245654
Regular
Feb 20, 2018

ERNESTO NAJERA vs. GENERAL WAX COMPANY, INC., TRAVELERS PROPERTY OF CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board dismissed Ernesto Najera's Petition for Reconsideration because it was not verified, as required by Labor Code section 5902. The WCJ's report notified the applicant of this defect, but it was not cured within a reasonable time. The Board noted that if not dismissed for procedural defect, the petition would have been denied on the merits.

Petition for ReconsiderationUnverified PetitionVerification DefectLabor Code Section 5902Cal. Code Regs. tit. 8 § 10450(e)Lucena v. Diablo Auto BodyNotice of DefectCure DefectCompelling ReasonAdministrative Law Judge Report
References
Case No. ADJ10543011 ADJ10419700
Regular
Jan 12, 2018

CHERIE BATES vs. PRIDE INDUSTRIES, Insured by UNITED STATES FIRE INS. CO., As Administered by BROADSPIRE 24016 FRESNO

The Workers' Compensation Appeals Board (WCAB) dismissed defendant Pride Industries' Petition for Reconsideration because it was unverified. Labor Code section 5902 requires such petitions to be verified. Although a lack of verification is not jurisdictional, the WCAB can dismiss the petition if the defect is not cured after notice. In this case, the WCJ's report alerted the defendant to the defect, and they failed to file a verification or offer a compelling explanation for its absence within a reasonable time.

Petition for ReconsiderationVerification DefectUnverified PetitionLabor Code Section 5902Code of Civil Procedure Section 446(a)WCAB Rule 10450(e)DismissalWings West Airlines v. Workers' Comp. Appeals Bd.Lucena v. Diablo Auto BodyNotice of Defect
References
Case No. ADJ7445855
Regular
Nov 25, 2019

SANTIAGO URENA vs. APPLIED COMPANIES, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board dismissed a lien claimant's petition for reconsideration as untimely, as it was filed 10 days after the deadline. The petition was also dismissed for failing to meet the statutory verification requirement and the claimant did not cure this defect within a reasonable time. The Board noted that even if timely and verified, the petition would have been denied on the merits.

Lien claimantPetition for ReconsiderationUntimelyUnverifiedJurisdictionalWCJ's Order of Lien DismissalLabor Code Section 5902Verification defectNotice of defectReasonable time
References
Case No. ADJ1448035 (VNO 0527697), ADJ2334907 (VNO 0527694)
Regular
Sep 01, 2015

FELIX MARTINEZ LUNA vs. LOS ANGELES METROPOLITAN TRANSIT AUTHORITY

This Workers' Compensation Appeals Board case involved a Petition for Reconsideration that was dismissed. The dismissal occurred because the petition was unverified, a requirement mandated by Labor Code section 5902. Despite notice of this defect, the petitioner failed to cure it by filing a verification or providing a valid explanation. Consequently, the Board dismissed the petition as per established precedent.

Petition for ReconsiderationUnverified PetitionLabor Code Section 5902Verification DefectNotice of DefectCure DefectCompelling ReasonNo PrejudiceWorkers' Compensation Appeals BoardDismissal Order
References
Case No. ADJ9938323
Regular
Aug 19, 2015

PIO HERNANDEZ VARGAS vs. LOS ARBOLES HARVESTING, INC., CALIFORNIA FARM MANAGEMENT, INTERCARE HOLDINGS INSURANCE SERVICES

This case involves a Petition for Removal that was dismissed by the Workers' Compensation Appeals Board (WCAB). The dismissal was based on the petition's failure to be verified, as required by WCAB Rules 10843(b) and 10450(e). The applicant was given notice of this defect but failed to cure it within a reasonable time. Even if it hadn't been dismissed for lack of verification, the petition would have been denied on its merits.

Petition for RemovalUnverified PetitionWCAB RulesWCJ ReportDismissalVerification DefectNotice of DefectCure DefectCompelling ReasonPrejudice
References
Case No. ADJ8231324
Regular
Jan 12, 2016

MARIA GUEVARA vs. DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed Maria Guevara's petition for reconsideration because it was unverified. Labor Code section 5902 mandates verification for such petitions. Guevara was notified of this defect, and despite a reasonable time passing, failed to cure it by filing a verification or providing a compelling explanation for its absence. Therefore, the WCAB dismissed the petition, noting it would have also been denied on the merits.

Petition for ReconsiderationVerifiedLabor Code section 5902Cal. Code Regs. tit. 8 § 10450(e)Lucena v. Diablo Auto BodyWCJ reportADJ8231324Unverified petitionNotice of defectCure defect
References
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