What the panel ordered
Petition for Reconsideration denied.
Defendant sought reconsideration of the Findings and Orders issued on April 16, 2024, which were recommended for denial by the WCJ's Report and Recommendation on Petition for Reconsideration.
This docket was decided more than once. Shown here is the latest released decision; we also hold June 28, 2022.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
Other disputed issueDefendant prevailedresidential treatment
The Appeals Board found no legal basis for defendant's claim for reimbursement of payments made for residential treatment because the utilization review determinations were untimely and invalid, and there was no evidence of fraud or unjust enrichment.
From the decision · page 7Although we discern no error in the WCJ's finding that the UR determinations were untimely and, as such, that applicant's medical treatment was not subject to UR, we nevertheless address defendant's contention that the record establishes its entitlement to reimbursement for payments made for residential treatment provided to applicant after it disputed the medical necessity of the treatment. Specifically, defendant argues that after it issued UR determinations denying applicant's requests for continued residential treatment, applicant was required by Labor Code section 4610.5 to seek IMR of the determinations or be bound by them--and that applicant's failure to seek IMR gives rise to a right of reimbursement. (Petition, p. 6:3-7.)