What the panel ordered
The July 9, 2021 Findings and Order is rescinded and the matter is returned to the WCJ for consideration of the parties' stipulations and further proceedings as appropriate.
Petition for reconsideration of the WCJ Findings and Order denied on July 9, 2021, was granted for further study and settlement consideration.
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 WCJ's denial of the petition for reconsideration was based on the lack of clear and convincing evidence to set aside the IMR determination, and the WCAB found no error in the WCJ's application of controlling case law but remanded for settlement consideration.
From the decision · page 1applicant, petitioned for reconsideration of the Findings and Order issued by the workers' compensation administrative law judge (WCJ) in this matter on July 9, 2021. In that decision, the WCJ denied applicant's appeal of the July 13, 2020 Independent Medical Review (IMR) final determination denying the request for authorization for extended Nucynta, finding, in part, that the applicant had not shown clear and convincing evidence sufficient to set aside the IMR determination, and that the determination of the Administrative Director dated July 13, 2020 remained in effect.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant did not show clear and convincing evidence to set aside the IMR determination denying authorization for extended Nucynta.
Favours Defendant prevailed
This lack of evidence supported the WCJ's denial of the petition for reconsideration and the WCAB's decision to rescind and remand for settlement consideration.
From the decision · page 1applicant, petitioned for reconsideration of the Findings and Order issued by the workers' compensation administrative law judge (WCJ) in this matter on July 9, 2021. In that decision, the WCJ denied applicant's appeal of the July 13, 2020 Independent Medical Review (IMR) final determination denying the request for authorization for extended Nucynta, finding, in part, that the applicant had not shown clear and convincing evidence sufficient to set aside the IMR determination, and that the determination of the Administrative Director dated July 13, 2020 remained in effect.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910
Applicant argued that Patterson supports reconsideration; WCJ did not address this assertion but WCAB granted reconsideration to study the issue further.
From the decision · page 1Applicant contends in his petition that the rationale in the Patterson decision (Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910, 2014 LEXIS 98) applies in this case, and that the WCJ failed to address applicant's assertion to that effect in his decision.
The McCool case is controlling precedent for denial of reconsideration of IMR determinations when no clear and convincing evidence is shown.
Defendant cited McCool to support the WCJ's denial of reconsideration; WCAB found the WCJ's reliance appropriate.
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About this page
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