ADJ13508500 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied

Petition for Reconsideration filed by defendant and denied by WCAB panel after review of WCJ report

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.

Reconsideration / removalApplicant prevailedpsyche

The WCAB panel adopted the WCJ's report and denied the petition for reconsideration because the defendant failed to comply with its duty to conduct a reasonable and good faith investigation and improperly rejected the medical evidence without clarification attempts.

From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, and for the reasons stated below, we will deny reconsideration.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

WCAB Rule 10109

Claims administrator must conduct a reasonable and timely investigation upon receiving notice or knowledge of an injury or claim for workers' compensation benefits.

Defendant failed to comply with this duty by not conducting a reasonable and good faith investigation and not clarifying medical report deficiencies.

From the decision · page 1Specifically, Workers' Compensation Appeals Board (WCAB) Rule 10109 provides, in relevant part:

Labor Code section 4063

Upon receipt of a report resolving an issue requiring compensation, defendant must provide compensation or file a Declaration of Readiness to Proceed.

Claims examiner incorrectly believed he had no duty to act on the medical report, leading to denial of benefits.

From the decision · page 6Labor Code section 4063 requires that on receipt of a report resolving an issue requiring a defendant to provide compensation, it must do so or file a Declaration of Readiness to Proceed. The claims examiner is incorrect that he has no duty when he makes a unilateral decision to reject the clear and unambiguous opinion of the evaluator. 3. Defendant made no formal attempts to receive additional records Defendant has argued that its discovery attempts were hampered by the failure of applicant to sign an unlimited release. However, it has shown no meaningful attempts to receive an unlimited release. The claims examiner can only recall with any detail one phone call to applicant requesting a second release. (Minutes of Hearing, Summary of Evidence, page 11, liens 1 to 4.) If defendant determined that it needed an unlimited release, it had the ability to seek WCAB intervention. There is no record of any efforts to do so. Instead it chose to unilaterally sit on its hands from the February 20, 2020, receipt of the time-limited release until its October 7, 2020, objection to applicant's DOR. Defendant clearly waived any right to insist on an unlimited release due to its delays.

ADJ13508500 · June 18, 2021

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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