What the panel ordered
The WCAB granted reconsideration, rescinded the March 21, 2025 Findings and Order, found the December 11, 2024 Utilization Review determination untimely, vested the WCAB with jurisdiction over the medical treatment dispute, and returned the matter to the trial level for further proceedings.
Applicant sought reconsideration of the March 21, 2025 Findings and Order by the WCJ, which found the RFA submitted on November 27, 2024 did not qualify for expedited review and was timely decided, resulting in the WCAB lacking jurisdiction over the medical treatment dispute. The WCAB granted reconsideration, rescinded the prior Findings and Order, and returned the matter to the trial level for further proceedings.
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.
The WCAB found that defendant's December 11, 2024 Utilization Review decision was untimely because no medical professional evaluated the need for expedited review within the required 72-hour timeframe, vesting the WCAB with jurisdiction over the medical treatment dispute.
From the decision · page 10Here, there is no evidence that a medical professional evaluated whether the RFA submitted on November 27, 2024 established the need for expedited review, or that any such determination was communicated to the prescribing physician within 72 hours of defendant's receipt of the RFA. As a result, defendant's December 11, 2024 Utilization Review decision was untimely, and the WCAB is vested with jurisdiction over the underlying medical treatment dispute. (Dubon v. World Restoration (2014) 79 Cal.Comp.Cases 1298 [2014 Cal. Wrk. Comp. LEXIS 131].) Accordingly, we will grant reconsideration, rescind the F&O, substitute new findings of fact that defendant's December 11, 2024 UR determination was untimely, and return this matter to the WCJ for determination of whether applicant has met the burden of establishing that the requested medical treatment is medically necessary under applicable medical treatment utilization schedule and recommended guidelines. (Lab. Code, § 4604.5; 5307.27 et seq.)