ADJ21055490 · October 8, 2026

The Petition was dismissed as premature because the WCJ did not hold a hearing or create a complete record to assess the parties' understanding of the C&R and the impact on Medicare benefits, requiring remand for hearing and record development.

From the decision · page 1Applicant filed a Petition for Reconsideration and Request to Set Aside and/or Amend the Compromise and Release and Order Approving the Compromise and Release (Petition) issued by the workers’ compensation judge (WCJ) on July 14, 2026. Applicant contends that the Compromise and Release (C&R) included body parts that were not industrially injured and that this error might negatively impact his Medicare benefits. We have not received an Answer from defendant. The WCJ prepared a Report and Recommendation on Petition for Reconsideration (Report), recommending that the Petition be denied. We have considered the allegations of the Petition and the contents of the Report with respect thereto. Based on our review of the record, for the reasons discussed below, we dismiss the Petition for Reconsideration so that the WCJ can consider it as one to set aside the Order Approving.

Medical reporting by QME Dr. Nazari did not support injury to applicant’s back despite back being included in C&R

Favours Applicant prevailed

This raised concerns about the adequacy of the settlement and potential negative impact on Medicare benefits, requiring further hearing and record development.

From the decision · page 5are due, they should be paid and the WCJ should ensure that payable benefits are not inappropriately shifted onto public systems, for example, Medicare, Medi-Cal, EDD, and Social Security. Adequacy review has the dual purpose of ensuring that an injured worker is appropriately paid benefits, which in turn benefits the public.” (Gaines v. ABM Aviation, supra,at p. 629.) Here, the medical reporting by QME Dr. Nazari does not support any injury to applicant’s back, even though the back was identified as a body part that was settled by way of the C&R. Additionally, there must be a complete record for our review of the case. “[A] proper record enables any reviewing tribunal, be it the Board on reconsideration or a court on further appeal, to understand the basis for the decision.” (Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 475 (Appeals Bd.

No hearing was held by WCJ on the matter; no Minutes of Hearing or Statement of Evidence in the record

Favours Applicant prevailed

Without a hearing, the WCJ could not assess the parties' understanding of the C&R or the impact on Medicare benefits, necessitating remand for a hearing.

From the decision · page 58, § 10803.) Finally, all parties in workers’ compensation proceedings retain their fundamental right to due process and a fair hearing under both the California and United States Constitutions. (Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) A fair hearing includes, but is not limited to, the opportunity to call and cross-examine witnesses; introduce and inspect exhibits; and to offer evidence in rebuttal. (Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584]; Rucker, supra, 82 Cal.App.4th at pp. 157-158, citing Kaiser Co. v. I.A.C. (1952) 109 Cal.App.2d 54, 58 [17 Cal.Comp.Cases 21]; Katzin v. Workers' Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 710-712 [57 Cal.Comp.Cases 230].) The OACR issued without a hearing on the matter. Because no hearing was held by the WCJ, the WCJ did not have the opportunity to assess the basis of the parties’ understanding of the C&R nor the impact on applicant’s Medicare benefits. There is no Minutes of Hearing or Statement of Evidence in the record. Although the WCJ made a general statement in the OACR that “all medical records and reports are taken into evidence at this time,” and medical reporting was submitted pursuant to WCAB Rule 10700(a) (Cal. Code Regs., tit. 8, § 10700(a)), there is no other

Identified permanent disability in applicant’s hip and left femoral neck; medical reporting did not support injury to applicant’s back despite back being included in C&R body parts.

Medical reporting did not support injury to back, which was included in the C&R, raising issues about adequacy of settlement and Medicare impact.

From the decision · page 2Qualified Medical Evaluator (QME) Nahid Nazari, M.D., MPH, examined applicant and issued a report dated January 2, 2025, and a supplemental report dated February 28, 2025. In his February 28, 2025 report, Dr. Nazari identified permanent disability in applicant’s hip and left femoral neck. The parties filed the C&R on July 6, 2026, and the Order Approving Compromise and Release (OACR) issued on July 14, 2026. The C&R identified the back and leg as the settled body parts. 1 In the Comments under Paragraph 9, it states that: “THIS SETTLEMENT IS BASED, IN PART, ON THE REPORTING OF DR. NAHID NAZAR[I].” Addendum B of the C&R included information about the Medicare Set Aside Allocation. The addendum states that the parties prepared a Medicare Set Aside (MSA) allocation that was attached to the settlement and incorporated. The addendum also stated that applicant desired to self-administer the MSA. (C&R, Addendum B & MSA letter, pp. 11, 13-17.) Applicant filed the Petition on August 4, 2026, with an attached declaration from applicant.

Labor Code section 5909

Petitions for reconsideration must be acted upon within 60 days from the date a trial judge transmits a case to the appeals board (Labor Code section 5909)

The Appeals Board acted timely on the Petition within the 60-day period after transmission on August 10, 2026.

From the decision · page 2Petitions for reconsideration filed on or after July 14, 2026 are subject to Labor Code 2 section 5909, which states that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board.

Cal. Code Regs., tit. 8, § 10700(b)

The WCAB must inquire into the adequacy of all Compromise and Release agreements and may set the matter for hearing to take evidence when necessary (Cal. Code Regs., tit. 8, § 10700(b))

The WCAB noted the need for a hearing to assess the parties' understanding of the C&R and Medicare impact due to lack of a complete record.

From the decision · page 4reimbursable by Medicare. (CMS Guide, p. 4.) Any claimant who receives a workers’ compensation settlement, judgment, or award that “includes an amount for future medical expenses must take Medicare’s interest with respect to future medicals into account.” (Id.) Therefore, the legal duty of the parties and the WCAB is to consider Medicare’s interests. The “Workers’ Compensation Appeals Board shall inquire into the adequacy of all Compromise and Release agreements and Stipulations with Request for Award, and may set the matter for hearing to take evidence when necessary to determine whether the agreement should be approved or disapproved, or issue findings and awards.” (Cal. Code Regs., tit.

Gaines v. ABM Aviation (2026) 91 Cal.Comp.Cases 613

A workers’ compensation settlement must provide fair compensation equivalent to an award and protect the injured worker and public interest (Gaines v. ABM Aviation (2026) 91 Cal.Comp.Cases 613)

The WCAB emphasized the need for adequacy review to protect the injured worker and public interest, noting the back was included in the C&R without medical support.

From the decision · page 48, § 10700(b).) We observe that contract principles apply to settlements of workers’ compensation disputes. Stipulations between the parties must be interpreted to give effect to the mutual intention of the parties it existed at the time of contracting, so far as the same is ascertainable and lawful. (County of San Joaquin v. Workers’ Compensation Appeals Bd. (Sepulveda) (2004) 117 Cal.App.4th 1180, 1184 [69 Cal.Comp.Cases 193], citing Civ. Code, § 1636.) As we held in our recent en banc decision in Gaines v. ABM Aviation (2026) 91 Cal.Comp.Cases 613, 615 (Appeals Board en banc), “[a] workers’ compensation settlement is only enforceable after approval by the Workers’ Compensation Appeals Board.

County of San Joaquin v. Workers’ Compensation Appeals Bd. (Sepulveda) (2004) 117 Cal.App.4th 1180

Stipulations must be interpreted to give effect to the mutual intention of the parties at the time of contracting (County of San Joaquin v. Workers’ Compensation Appeals Bd. (Sepulveda) (2004) 117 Cal.App.4th 1180)

The WCAB applied contract principles to interpret the C&R and assess adequacy and mutual intention.

From the decision · page 48, § 10700(b).) We observe that contract principles apply to settlements of workers’ compensation disputes. Stipulations between the parties must be interpreted to give effect to the mutual intention of the parties it existed at the time of contracting, so far as the same is ascertainable and lawful. (County of San Joaquin v. Workers’ Compensation Appeals Bd. (Sepulveda) (2004) 117 Cal.App.4th 1180, 1184 [69 Cal.Comp.Cases 193], citing Civ. Code, § 1636.) As we held in our recent en banc decision in Gaines v. ABM Aviation (2026) 91 Cal.Comp.Cases 613, 615 (Appeals Board en banc), “[a] workers’ compensation settlement is only enforceable after approval by the Workers’ Compensation Appeals Board.

Medical reporting by QME Dr. Nazari did not support injury to applicant’s back despite back being included in C&R

From the decision · page 5are due, they should be paid and the WCJ should ensure that payable benefits are not inappropriately shifted onto public systems, for example, Medicare, Medi-Cal, EDD, and Social Security. Adequacy review has the dual purpose of ensuring that an injured worker is appropriately paid benefits, which in turn benefits the public.” (Gaines v. ABM Aviation, supra,at p. 629.) Here, the medical reporting by QME Dr. Nazari does not support any injury to applicant’s back, even though the back was identified as a body part that was settled by way of the C&R. Additionally, there must be a complete record for our review of the case. “[A] proper record enables any reviewing tribunal, be it the Board on reconsideration or a court on further appeal, to understand the basis for the decision.” (Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 475 (Appeals Bd.

No hearing was held by WCJ on the matter; no Minutes of Hearing or Statement of Evidence in the record

From the decision · page 58, § 10803.) Finally, all parties in workers’ compensation proceedings retain their fundamental right to due process and a fair hearing under both the California and United States Constitutions. (Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) A fair hearing includes, but is not limited to, the opportunity to call and cross-examine witnesses; introduce and inspect exhibits; and to offer evidence in rebuttal. (Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584]; Rucker, supra, 82 Cal.App.4th at pp. 157-158, citing Kaiser Co. v. I.A.C. (1952) 109 Cal.App.2d 54, 58 [17 Cal.Comp.Cases 21]; Katzin v. Workers' Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 710-712 [57 Cal.Comp.Cases 230].) The OACR issued without a hearing on the matter. Because no hearing was held by the WCJ, the WCJ did not have the opportunity to assess the basis of the parties’ understanding of the C&R nor the impact on applicant’s Medicare benefits. There is no Minutes of Hearing or Statement of Evidence in the record. Although the WCJ made a general statement in the OACR that “all medical records and reports are taken into evidence at this time,” and medical reporting was submitted pursuant to WCAB Rule 10700(a) (Cal. Code Regs., tit. 8, § 10700(a)), there is no other