ADJ118647 · June 8, 2026

Applicant failed to identify any specific late mileage reimbursement request or prove entitlement to a penalty for late reimbursement.

From the decision · page 10Applicant did not meet her burden of showing that she should be awarded a penalty on late mileage for treatment for her neck and bilateral shoulders. She did not identify any particular mileage reimbursement request that was late. She did not indicate when they were sent to Defendant or when she received payment. Teri Thompson, program coordinator for the City of San Diego and current adjuster for Applicant's claim, credibly testified that she had issues with Applicant's mileage reimbursement requests. The issues varied but sometimes the requests were not legible, or had dates of service that were cut off, or were requesting mileage for treatment for body parts that were not industrial body parts, or were requesting mileage where the location where treatment occurred was not clear. When problems with mileage requests were noted, applicant would receive in writing why there was a problem with her mileage requests (May 22, 2025 Summary of Evidence, page 2, lines 10-22). For the reasons stated above, applicant did not meet her burden of showing that she should be awarded a penalty for late mileage reimbursement.

Applicant failed to prove permanent disability or apportionment for her industrial injury to the neck and bilateral shoulders by a preponderance of the evidence.

From the decision · page 8After reviewing all the evidence presented, including the testimony of the current claims adjuster and the Applicant, the undersigned determined there was no substantial medical evidence on the issue of Applicant's permanent disability for her admitted injuries and ordered that parties to undergo the Panel Qualified Medical process. Although admittedly it is unclear, Applicant does

Applicant did not provide substantial medical evidence or a Request for Authorization from a treating physician to show that a service dog was reasonable and necessary medical treatment for her industrial injury.

From the decision · page 9Applicant referenced some documents in her Petition for Reconsideration that she believed showed that she needed a service dog on a medical basis for her industrial injury. One document was identified on page 7 of the Petition for Reconsideration as a "2011 PTP order for a service dog" (Applicant's Exhibit 65, page 44). This document appears to be a prescription from Coast Pain Management with an illegible date. It stated "Pt requires service dog due to the applicant having significant functional limitations." After reviewing all the evidence, the Workers' Compensation Administrative Law Judge "WCJ" noted that there was no Request for Authorization form or RFAs in the exhibits by a treating physician requesting that Applicant be provided with a service dog for her industrial injury. There was no medical report in evidence that constituted substantial medical evidence that outlined why a service dog would be needed on an industrial medical basis for Applicant's bilateral shoulder and neck injury. For the above reasons, Applicant did not meet her burden of showing that her service dogs were needed on a medical basis for her industrial injury to her neck and bilateral shoulders.

Applicant failed to produce credible evidence that defendant withheld medical reports or that any withheld records would have affected the prior trial outcome.

From the decision · page 10Applicant failed to produce any credible evidence that Defendant withheld medical reports that were in their possession prior to February 8, 2016 but were not served until after the trial with Judge Ellison was completed. Nor has she shown that any alleged withheld records would have made a difference in the outcome of her trial with Judge Ellison.

Applicant failed to provide credible or substantial evidence to prove the need for a service dog on an industrial medical basis for her neck and bilateral shoulder injury.

Favours Defendant prevailed

This failure led to denial of the claim for service dog medical necessity.

From the decision · page 9Applicant referenced some documents in her Petition for Reconsideration that she believed showed that she needed a service dog on a medical basis for her industrial injury. One document was identified on page 7 of the Petition for Reconsideration as a "2011 PTP order for a service dog" (Applicant's Exhibit 65, page 44). This document appears to be a prescription from Coast Pain Management with an illegible date. It stated "Pt requires service dog due to the applicant having significant functional limitations." After reviewing all the evidence, the Workers' Compensation Administrative Law Judge "WCJ" noted that there was no Request for Authorization form or RFAs in the exhibits by a treating physician requesting that Applicant be provided with a service dog for her industrial injury. There was no medical report in evidence that constituted substantial medical evidence that outlined why a service dog would be needed on an industrial medical basis for Applicant's bilateral shoulder and neck injury. For the above reasons, Applicant did not meet her burden of showing that her service dogs were needed on a medical basis for her industrial injury to her neck and bilateral shoulders.

Applicant did not identify any specific late mileage reimbursement request or prove entitlement to a penalty for late reimbursement.

Favours Defendant prevailed

This lack of proof led to denial of the penalty claim for late mileage reimbursement.

From the decision · page 10Applicant did not meet her burden of showing that she should be awarded a penalty on late mileage for treatment for her neck and bilateral shoulders. She did not identify any particular mileage reimbursement request that was late. She did not indicate when they were sent to Defendant or when she received payment. Teri Thompson, program coordinator for the City of San Diego and current adjuster for Applicant's claim, credibly testified that she had issues with Applicant's mileage reimbursement requests. The issues varied but sometimes the requests were not legible, or had dates of service that were cut off, or were requesting mileage for treatment for body parts that were not industrial body parts, or were requesting mileage where the location where treatment occurred was not clear. When problems with mileage requests were noted, applicant would receive in writing why there was a problem with her mileage requests (May 22, 2025 Summary of Evidence, page 2, lines 10-22). For the reasons stated above, applicant did not meet her burden of showing that she should be awarded a penalty for late mileage reimbursement.

Applicant failed to produce credible evidence that defendant withheld medical reports prior to February 8, 2016, or that any withheld records would have affected the prior trial outcome.

Favours Defendant prevailed

This failure led to denial of the claim regarding withholding of medical reports.

From the decision · page 10Applicant failed to produce any credible evidence that Defendant withheld medical reports that were in their possession prior to February 8, 2016 but were not served until after the trial with Judge Ellison was completed. Nor has she shown that any alleged withheld records would have made a difference in the outcome of her trial with Judge Ellison.

Dr. Maywood testified in a 2010 deposition that the applicant did not need additional surgery to her right shoulder and found her to be at maximum medical improvement in 2009. He also expressed a negative opinion about the applicant's honesty and characterized her as a malingerer.

The tribunal found no credible evidence of a surgery order from Dr. Maywood and relied on his deposition testimony that no additional surgery was needed and his negative credibility assessment of the applicant.

From the decision · page 11additional surgery to her right shoulder (Defendant's Exhibit D, admitted into evidence in the 2016 trial). He answered that she did not need additional surgery (Defendant's Exhibit D, page 7, lines 10-15). The May 4, 2010 deposition of Dr. Maywood is the last record from Dr. Maywood in this matter. Dr. Maywood saw the Applicant for the last time in 2009 when he found her to be MMI. (Defense Exhibit D, page 7, lines 5-9). Dr. Maywood also gave his opinions of Applicant in that deposition. He stated the following:

Lab. Code, 5705

Burden of proof on the party holding the affirmative of an issue to prove each fact by a preponderance of the evidence.

Applicant failed to meet her burden of proof on issues of late mileage reimbursement, need for a service dog, and withholding of medical records.

From the decision · page 5Next, the burden of proof rests on the party holding the affirmative of an issue. (Lab. Code, § 5705.) To meet her burden, applicant was required to prove each fact supporting her claim by a preponderance of the evidence. "`Preponderance of the evidence' means that evidence that when weighed with that opposed to it, has more convincing force and the greater probability of truth."

Testimony of Teri Thompson, program coordinator and claims adjuster, regarding issues with applicant's mileage reimbursement requests such as illegibility and unclear treatment locations.

From the decision · page 10Applicant did not meet her burden of showing that she should be awarded a penalty on late mileage for treatment for her neck and bilateral shoulders. She did not identify any particular mileage reimbursement request that was late. She did not indicate when they were sent to Defendant or when she received payment. Teri Thompson, program coordinator for the City of San Diego and current adjuster for Applicant's claim, credibly testified that she had issues with Applicant's mileage reimbursement requests. The issues varied but sometimes the requests were not legible, or had dates of service that were cut off, or were requesting mileage for treatment for body parts that were not industrial body parts, or were requesting mileage where the location where treatment occurred was not clear. When problems with mileage requests were noted, applicant would receive in writing why there was a problem with her mileage requests (May 22, 2025 Summary of Evidence, page 2, lines 10-22). For the reasons stated above, applicant did not meet her burden of showing that she should be awarded a penalty for late mileage reimbursement.