ADJ20774534 — California WCAB decision

What the panel ordered

Applicant's Petition for Reconsideration is dismissed as premature and the matter is returned to the WCJ for further proceedings.

Applicant filed a Petition for Reconsideration of an Order Approving Compromise and Release (OACR); the Appeals Board treated the Petition as one for reconsideration and dismissed it as premature, returning the matter to the trial level for further proceedings.

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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 / removalNot reached

The Petition for Reconsideration was premature because the record was insufficient to evaluate whether good cause existed to set aside the OACR; the matter should be returned to the WCJ for further proceedings and record development.

From the decision · page 7Accordingly, we treat the Petition as one seeking reconsideration, dismiss the Petition as premature, and return the matter to the WCJ for further proceedings consistent with this opinion. Upon return of this matter to the trial level, we recommend that the WCJ treat the Petition as a petition to set aside, including setting a hearing to allow the parties to provide evidence and create a record upon which a decision can be made by the WCJ. After the WCJ issues a decision, any aggrieved person may then timely seek reconsideration of that decision.

The facts that decided it

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

Applicant and her attorney were not served with the UR determination approving surgery until after the C&R was signed, and this information was not provided to the WCJ at the time of approval.

Favours Applicant prevailed

This fact prevented the WCJ from evaluating the adequacy of the settlement and was central to the applicant's request to set aside the OACR.

From the decision · page 6Here, applicant signed the C&R on July 10, 2025. Applicant's attorney states that the requested shoulder surgery was approved on or about July 14, 2025, although neither applicant nor her attorney were served with the UR determination until August 1, 2025. Applicant's attorney contends that if he had known that the shoulder surgery was approved, he would not have recommended settlement. Given that applicant settled all of her rights to medical treatment by way of the C&R, the cost of the approved surgery could significantly impact the value of applicant's case.

Defendant's attorney is presumed to have knowledge of information available to her client, including the UR approval, and due diligence required inquiry before settlement.

Favours Applicant prevailed

This fact raised questions about whether the settlement was entered into with full knowledge and mutual agreement, impacting the validity of the C&R.

From the decision · page 6Defendant signed the C&R on July 15, 2025. In the C&R, defendant required that applicant waive her right to a qualified medical evaluator (QME) as a condition of settlement. While defendant's attorney may or may not have actually known that defendant's UR organization approved applicant's surgery before she signed the C&R, defendant's attorney is presumed to have knowledge of information that is readily available to her client. At a minimum, due diligence requires that she would have inquired before requiring applicant to settle her rights to medical treatment and waive her rights to a medical-legal evaluation. Moreover, this information was important to provide to the WCJ so that he could meaningfully evaluate whether the settlement was adequate.

The rules the panel named

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

Lab. Code § 5909 (as amended July 2, 2024)

A petition for reconsideration is deemed denied unless acted upon within 60 days from the date a trial judge transmits a case to the appeals board; service of the accompanying report constitutes notice of transmission.

The Board must act within 60 days of transmission, and notice is provided by service of the Report.

From the decision · page 3Under section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board. Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS). Specifically, in Case Events, under Event Description is the phrase "Sent to Recon" and under Additional Information is the phrase "The case is sent to the Recon board."

Johnson v. Workmen's Comp. Appeals Bd. (1970) 2 Cal.3d 964, 975 [35 Cal.Comp.Cases 362]; Smith v. Workers' Comp. Appeals Bd. (1985) 168 Cal.App.3d 1160, 1170 [50 Cal.Comp.Cases 311]

Good cause to set aside an order or stipulations depends upon the facts and circumstances of each case, including mutual mistake of fact, duress, fraud, undue influence, and procedural irregularities.

The Board must assess the circumstances surrounding execution and approval of settlements to determine if good cause exists to rescind.

From the decision · page 5To determine whether there is good cause to rescind awards and stipulations, the circumstances surrounding their execution and approval must be assessed. (See Lab. Code, § 5702; Weatherall, supra, 1118-1121; Robinson v. Workers' Comp. Appeals Bd. (1987) 194 Cal.App.3d 784, 790-792 [52 Cal.Comp.Cases 419]; Huston v. Workers' Comp. Appeals Bd. (1979) 95 Cal.App.3d 856, 864-867 [44 Cal.Comp.Cases 798].) "Good cause" to set aside an order or stipulations depends upon the facts and circumstances of each case. "Good cause" includes, but is not limited to, mutual mistake of fact, duress, fraud, undue influence, and procedural irregularities. (Johnson v. Workmen's Comp. Appeals Bd. (1970) 2 Cal.3d 964, 975 [35 Cal.Comp.Cases 362]; Smith v. Workers' Comp. Appeals Bd. (1985) 168 Cal.App.3d 1160, 1170 [50 Cal.Comp.Cases 311].)

ADJ20774534 · October 10, 2025

What the panel ordered

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