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

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. 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. 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. ADJ8890512
Regular
Aug 23, 2018

JUANA FLORES vs. MCDONALD'S, UNITED STATES FIDELITY AND GUARANTY COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) dismissed Juana Flores's petition for reconsideration because it was unverified, violating Labor Code section 5902. The WCJ's report provided notice of this defect, yet Ms. Flores failed to cure it by filing a verification or providing a compelling explanation within a reasonable time. Had the petition not been dismissed for procedural defect, the WCAB would have denied it on the merits, adopting the WCJ's findings and giving great weight to their credibility determination.

Petition for ReconsiderationVerifiedLabor Code section 5902Cal. Code Regs.tit. 8§ 10450(e)Lucena v. Diablo Auto BodyUnverified PetitionDismissalWCJ Report
References
Case No. ADJ10070672 ADJ10070673 ADJ10070674
Regular
Sep 12, 2018

JOAO GOMEZ vs. JP ELECTRIC SERVICES, INC, NEW YORK MARINE \& GENERAL INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a finding of contempt and award of fees against applicant's law firm, Gordon & Gordon. The WCAB found the original order procedurally defective, lacking proper notice and findings for contempt and sufficient documentation for the fee award. While rescinding the sanctions, the WCAB strongly admonished Gordon & Gordon for its repeated failures to appear, stating that proper procedures could have led to valid sanctions. The matter was returned to the trial level for further proceedings.

Petition for ReconsiderationContempt of CourtFee AwardProcedural DefectSubstantive DefectFailure to AppearShow Cause HearingLabor Code Section 5813SanctionsDue Process
References
Case No. ADJ1170790 (OAK 0325000)
Regular
Oct 15, 2008

ROBERTO LIMON vs. CHEVRON OCIP/INTERSTATE SCAFFOLDING, ZURICH AMERICAN INSURANCE COMPANY

This case involves an applicant's petition for reconsideration of a Compromise and Release settlement. The Workers' Compensation Appeals Board dismissed the petition because it was filed untimely. Even if timely, the Board would have denied reconsideration on the merits due to procedural defects and lack of good cause to set aside the settlement.

Petition for ReconsiderationCompromise and ReleaseUntimely FilingProof of ServiceLabor Code §5903WCAB RulesAdministrative Law JudgeDismissalJurisdictionGrounds for Reconsideration
References
Case No. ADJ8752928
Regular
Feb 23, 2016

BRAD MITCHELL vs. MARILYN GREENBERG LOAN ACCOUNTS, AAA NORTHERN CALIFORNIA INSURANCE EXCHANGE, administered by TRISTAR RISK MANAGEMENT

This case is dismissed because the Applicant's Petition for Reconsideration was unverified, violating Labor Code section 5902 and related regulations. The Applicant was given notice of this defect and a reasonable time to cure it, but failed to do so. Additionally, the petition lacked the required proof of service. If not for the procedural defect, the petition would have been denied on its merits.

Petition for ReconsiderationUnverified PetitionVerification RequirementLabor Code Section 5902Lucena v. Diablo Auto BodySignificant Panel DecisionWCJ ReportProof of ServiceLabor Code Section 5905Workers' Compensation Appeals Board
References
Case No. BAK 0136834
Regular
Dec 28, 2007

JOSE M. DELVILLAR vs. IRISH CONSTRUCTION, NATIONAL UNION FIRE INSURANCE COMPANY, AMERICAN INTERNATIONAL CLAIMS SERVICES (Adjusting Agent)

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because it was not verified as required by Labor Code section 5902. The defect was pointed out by the administrative law judge, and the defendant failed to cure it or provide a valid explanation within a reasonable time. Therefore, the petition was dismissed for procedural defect.

Petition for ReconsiderationVerifiedLabor Code section 5902Lucena v. Diablo Auto BodyWCJ's ReportDismissedFindings of Fact and AwardAdministrative Law JudgeDefectCure defect
References
Case No. ADJ350092 (LBO 0372531)
Regular
Apr 23, 2010

PATRICK FOOTE vs. MEDADENT BIOMEDICAL; SCIF INSURED SANTA ANA

The Workers' Compensation Appeals Board dismissed Patrick Foote's petition for reconsideration because it was unverified and lacked proof of service, violating Labor Code sections 5902 and 5905. The Board noted that the applicant had ample opportunity to cure these defects but failed to do so. Even if the procedural defects were overlooked, the Board would have denied the petition based on the original administrative law judge's findings. Ultimately, the petition was dismissed for non-compliance with procedural requirements.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalIndustrial InjuryPsycheUpper BackNeckHeadIn Pro PerUnverified Petition
References
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