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PanelQMEDenied

Kallash, Jian

JIAN KALLASH, Applicant vs. MACYS, Permissibly Self-Insured, Administered by SEDGWICK CLAIMS MANAGEMENT, Defendants

ADJ number: ADJ12663627
Decision date: Mar 17, 2025
District office: San Diego
WCJ: Alicia D. Hawthorne
Claim administrator: Sedgwick Claims Management Services (administering for Macy's, permissibly self-insured)
Commissioners: —

Injury / body parts: lumbar spine

LC §5909LC §5900LC §4604.5CCR §9792.9.1CCR §9792.6.1

Summary

Macy's (permissibly self-insured, administered by Sedgwick) petitioned for reconsideration of a December 20, 2024 Findings and Award in which the WCJ found applicant Jian Kallash entitled to an anterior lumbar interbody fusion at L5-S1 and related treatment requested by treating physician Dr. Abitbol. The WCJ found defendant's UR denial untimely and, exercising WCAB jurisdiction under Dubon II and Sandhagen, determined the surgery was reasonable and necessary based on substantial medical evidence from Dr. Abitbol, primary treater Dr. Kupfer, and QME Dr. Esch. The Appeals Board first addressed timeliness under amended Labor Code section 5909, finding it acted within 60 days of the January 17, 2025 transmission of the case. On the merits, the Board adopted and incorporated the WCJ's Report and Opinion on Decision and denied reconsideration.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.