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PanelQMEDismissed

Sutti, Marcus

MARCUS SUTTI, Applicant vs. CRYSTAL CREAMERY, permissibly self-insured, administered by GALLAGHER BASSETT, Defendants

ADJ number: ADJ17468996
Decision date: Nov 18, 2024
District office: Lodi
WCJ: Paul Saltzen
Claim administrator: Gallagher Bassett (administering for permissibly self-insured Crystal Creamery)
Commissioners: —

Injury / body parts: lumbar spine, low back, left lower extremity

LC §3202.5LC §4600LC §4604.5LC §4610LC §5307.27LC §5705LC §5813LC §5814LC §5900LC §5909CCR §10101.1CCR §10421CCR §10974

Summary

Applicant Marcus Sutti sought authorization for lumbar laminectomy surgery (L3-4) per a February 5, 2024 RFA. Defendant Crystal Creamery (self-insured, administered by Gallagher Bassett) repeatedly failed to appear in person at scheduled hearings and trials and failed to respond to two WCJ orders requiring it to explain its August 30, 2023 non-appearance. The WCJ found that defendant never issued a timely UR decision on the RFA, allowing the WCAB to determine medical necessity under Dubon II, and awarded the requested surgery while imposing $750 in sanctions ($250 for failing to comply with two orders and $500 for failing to appear at the May 7, 2024 trial). Defendant sought removal of the trial-continuance order and reconsideration of the F&O. The Board dismissed the removal petition as moot (trial having proceeded) and denied reconsideration, adopting the WCJ's reasoning that the surgery award was supported by substantial medical evidence and that defendant's conduct warranted sanctions under section 5813.

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.