What the panel ordered
Petition for Reconsideration denied.
Petition for Reconsideration of the Findings and Order with Opinion on Decision issued on January 13, 2026, denied by the WCAB panel decision dated April 27, 2026.
This docket was decided more than once. Shown here is the latest released decision; we also hold February 10, 2025.
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 lacks jurisdiction over the claim because the ADR program holds prima facie jurisdiction and the applicant did not seek review of the ADR closure, thus the WCAB cannot hear the claim except as an appeal from the ADR arbitrator's ruling.
From the decision · page 1Applicant seeks reconsideration or removal of the Findings and Order with Opinion on Decision (F&O) issued on January 13, 2026, wherein the workers' compensation administrative law judge (WCJ) found that (1) while employed as an electrician by Taft Electric Company, per the filed application dated June 16, 2022, applicant claims to have sustained cumulative injury during the period November 12, 2020 through November 12, 2021, to his neck, back, and bilateral feet; (2) the claim was denied by Gallagher Bassett Services, and no benefits have been paid; (3) the NECA/IBEW Alternative Dispute Resolution (ADR) program on its face is a valid ADR program that has been recognized and repeatedly authorized by the Administrative Director (AD) and holds prima facie jurisdiction over applicant's claim, and applicant has not proven that it fails to meet the requirements of Labor Code section 3201.5(b) or violates his right to a fair hearing.
Applicant's assertions of ombudsman misconduct are unsupported by evidence and rejected for lack of jurisdiction and evidentiary support.
From the decision · page 12However, as the WCJ states in the Report, applicant asserts without evidence that the ombudsman failed to fulfill his duties or disclose conflicts of interest. (Report, pp. 12-13.) Hence we admonish applicant's attorney to support all evidentiary statements in pleadings filed with the
The ADR program is valid on its face and as applied; the applicant failed to timely request a QME as required, and the WCAB lacks jurisdiction to review the ADR program's closure of the claim.
From the decision · page 11Accordingly, we discern no grounds to conclude the ADR program is facially invalid
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant failed to timely request a QME within 30 days as required by the ADR program rules after receiving the Ombudsman's letter.
Favours Defendant prevailed
This failure led to administrative closure of the claim and loss of jurisdiction by the WCAB to hear the claim.
Applicant was represented by counsel at the time of receiving the Ombudsman's letter but did not timely act on it.
Favours Defendant prevailed
Representation meant the applicant had the opportunity to timely respond but failed, supporting the validity of the ADR program's actions.
Applicant did not seek review of the ADR program's administrative closure of his claim.
Favours Defendant prevailed
Without seeking review, the WCAB lacks jurisdiction to hear the claim, affirming the ADR program's jurisdictional primacy.
From the decision · page 12Since we may only exercise jurisdiction over a dispute arising out of the ADR program where review of a decision is sought, and since applicant did not seek review of the closure of his claim in ADR, we lack jurisdiction to determine the validity of the closure of applicant's claim. (See Costa, supra.)
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Applicant attempted to schedule a QME evaluation with Dr. Smolins, but the defendant canceled it, contributing to the dispute over the ADR process.
From the decision · page 4On March 21, 2023, Applicant's attorney e-filed a DOR requesting a status conference on the issues of Applicant's attempt to schedule a QME evaluation with David Smolins, M.D., and defendant's cancellation of same, and further alleging the ADR Program's ombudsman, Richard Robyn, and defense counsel were non- responsive to efforts to resolve the dispute. (See EAMS/Filenet on that date.) It further asserted that the Applicant has received no benefits and that a med/legal evaluation was necessary to move the case forward. (Id.) Defense counsel filed an objection to that DOR dated March 30, 2023, citing the previous dismissal of the case per the order dated September 19, 2022, which was not objected to and/or the subject of any Petition for Reconsideration and/or Removal and was therefore final, and additionally that the WCAB lacks jurisdiction. (See EAMS/Filenet on that date.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 3201.5(b)
Labor Code section 3201.5(b) regarding the validity and jurisdiction of ADR programs.
The ADR program is recognized as valid and holds prima facie jurisdiction over the claim, limiting WCAB jurisdiction.
From the decision · page 1Applicant seeks reconsideration or removal of the Findings and Order with Opinion on Decision (F&O) issued on January 13, 2026, wherein the workers' compensation administrative law judge (WCJ) found that (1) while employed as an electrician by Taft Electric Company, per the filed application dated June 16, 2022, applicant claims to have sustained cumulative injury during the period November 12, 2020 through November 12, 2021, to his neck, back, and bilateral feet; (2) the claim was denied by Gallagher Bassett Services, and no benefits have been paid; (3) the NECA/IBEW Alternative Dispute Resolution (ADR) program on its face is a valid ADR program that has been recognized and repeatedly authorized by the Administrative Director (AD) and holds prima facie jurisdiction over applicant's claim, and applicant has not proven that it fails to meet the requirements of Labor Code section 3201.5(b) or violates his right to a fair hearing.
Cal. Code Regs., tit. 8, 10945
Cal. Code Regs., tit. 8, 10945 regarding evidentiary support for pleadings.
Applicant's attorney was admonished to support evidentiary statements with specific references or face denial of future petitions.
From the decision · page 12However, as the WCJ states in the Report, applicant asserts without evidence that the ombudsman failed to fulfill his duties or disclose conflicts of interest. (Report, pp. 12-13.) Hence we admonish applicant's attorney to support all evidentiary statements in pleadings filed with the
What proof carried it
The evidence the panel weighed, by kind.
Applicant's failure to timely respond to the Ombudsman's letter and submit a QME request within 30 days as required by the ADR program rules.
Applicant was represented by counsel at the time he received the Ombudsman's letter but failed to timely act on it.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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