WCPanelIQ
PanelDenied

Moss, Earl

EARL MOSS, Applicant vs. KAISER FOUNDATION HEALTH PLAN, PERMISSIBLY SELF-INSURED, Defendants

ADJ number
ADJ4668467
Decision date
Nov 24, 2024
District office
Oakland
WCJ
Lilla J. Szelenyi
Claim administrator
Kaiser Foundation Health Plan (Permissibly Self-Insured)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: right upper extremity

LC §123.6LC §3201LC §3209LC §5311LC §5410LC §5709LC §5803LC §5804LC §5814LC §5900LC §5909CCR §10517CCR §10960CCR §10964

Summary

Applicant Earl Moss sustained a right upper extremity injury on January 3, 2006, while working for Kaiser Foundation Health Plan, and the case in chief resolved via an April 13, 2011 Award including open future medical care. Applicant filed a Petition to Reopen on July 25, 2016 (more than ten years after injury and well beyond five years), alleging delayed treatment, refusal to provide documentation, failure to reimburse mileage/out-of-pocket expenses, and inadequate prior counsel. The WCJ dismissed the petition as untimely under Labor Code section 5804. The Board agreed that, to the extent the petition sought to alter/amend the 2011 Award, it was time-barred, but liberally construed the pleading as a section 5814 penalty petition for unreasonable delay in benefits—an issue the WCJ had deferred and which remains pending. The Board denied both the Petition for Reconsideration and the Petition for Disqualification of the WCJ, while reminding the WCJ of ethical obligations under Canon 3 of the Code of Judicial Ethics.

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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