ADJ6711342 · February 2, 2026

The WCJ found no dental injury and denied reimbursement to Dental Trauma Center but awarded Sleep Treatment Clinics reimbursement; the WCAB granted reconsideration due to due process concerns and ordered further review and mediation.

From the decision · page 2On 11/5/2025, this Court issued the Findings, Award and Orders and Opinion on Decision. This Court found, as indicated above, that Applicant did not sustain dental injury as alleged, the services provided by lien claimant, Dental Trauma Center, were not reasonable nor necessary, there was basis to award any additional reimbursement for the lien claim of Dental Trauma Center, the services provided

Applicant was not served with the Findings, Award and Orders or multiple minutes of hearing impacting future medical treatment rights.

Favours Applicant prevailed

This raised significant due process concerns affecting the fairness of the hearing and the validity of the WCJ's findings on dental injury and lien reimbursement.

From the decision · page 5Applicant presently has a stipulated award at 100% permanent total disability, which includes an ongoing lifetime award of medical treatment. The F&A issued by the WCJ could be construed as having issued against applicant in finding that applicant did not sustain a dental injury, notwithstanding the fact that "teeth" is listed as a body part in the stipulations between applicant and defendant. It does not appear that applicant was served with the F&A, or multiple minutes of hearing, including the hearing wherein a significant issue impacting applicant's right to future medical treatment was submitted for decision. This appears to create a significant issue of due process.

Issued one medical report dated 11/12/2017 regarding dental injury dispute.

From the decision · page 2This case involves an admitted specific injury wherein Applicant was involved a motor vehicle accident while driving a bus on 1/8/2009, striking and killing a pedestrian. Defendant admitted injury to the psyche, cardiovascular system, digestive system, peripheral nerve system, diabetes, left upper extremity, left-sided numbness, and sleep disorder, but denied the dental injury claim. To help resolve the pending dispute regarding the dental injury, Applicant and Defendant utilized the services of an agreed medical examiner in dentistry, Dr. Cheri Lewis, who issued one medical report dated 11/12/2017 (Defendant's Exhibit I).

Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal. Comp. Cases 1588, 1592 (Appeals Board en banc)

A lien claimant must prove entitlement to payment for industrially-related medical treatment by a preponderance of the evidence.

Lien claimant stands in the shoes of the injured employee and must prove all elements necessary to establish the lien.

From the decision · page 4II. Lien claimants assert a right to reimbursement for services provided to applicant in the underlying case in chief, which resolved by way of Stipulations with Request for Award on May 18, 2021. "Where a lien claimant (rather than the injured employee) is litigating the issue of entitlement to payment for industrially-related medical treatment, the lien claimant stands in the shoes of the injured employee and the lien claimant must prove by preponderance of the evidence all of the elements necessary to the establishment of its lien." (Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal. Comp. Cases 1588, 1592 (Appeals Board en banc).) All parties to a workers' compensation proceeding retain the 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 is "... one of `the rudiments of fair play' assured to every litigant..." (Id. at 158.) As stated by the California Supreme Court in Carstens v. Pillsbury (1916) 172 Cal. 572, "[The]

Lab. Code, 5909

A petition for reconsideration must be acted upon within 60 days of transmission to the Appeals Board, with notice to parties.

The Appeals Board must act on the petition within 60 days of transmission, and parties must be notified of the transmission date.

From the decision · page 3Former section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that:

Applicant was not served with the Findings, Award and Orders or multiple minutes of hearing impacting future medical treatment rights, raising due process concerns.

From the decision · page 5Applicant presently has a stipulated award at 100% permanent total disability, which includes an ongoing lifetime award of medical treatment. The F&A issued by the WCJ could be construed as having issued against applicant in finding that applicant did not sustain a dental injury, notwithstanding the fact that "teeth" is listed as a body part in the stipulations between applicant and defendant. It does not appear that applicant was served with the F&A, or multiple minutes of hearing, including the hearing wherein a significant issue impacting applicant's right to future medical treatment was submitted for decision. This appears to create a significant issue of due process.