JOSE VARGAS, Applicant vs. ADORNO CONSTRUCTION, INC., administrative functions performed by BBSI; ACE AMERICAN INSURANCE COMPANY, administered by CORVEL, Defendants
ADJ number
ADJ16099603
Decision date
Aug 5, 2024
District office
Oakland
WCJ
Christopher Miller
Claim administrator
CorVel (administering for ACE American Insurance Company); BBSI performed administrative functions for the employer
Jose Vargas, a construction foreman, sustained an admitted injury to his left shoulder on February 23, 2022, and underwent rotator cuff surgery on July 5, 2022. When symptoms persisted, his treating surgeon Dr. Schwartz requested authorization on August 8, 2023, for a further arthroscopic procedure. Defendant claimed it did not receive the RFA until December 13, 2023, and issued a UR denial on December 20, 2023. The WCJ inferred that the request had been conveyed before December 13 (supported by a fax cover sheet asserting transmission on 8/25/2023, applicant correspondence, and a QME report referencing the surgical request), and concluded the UR was untimely and thus inadmissible. Finding Dr. Schwartz's reporting adequately justified the surgery, the WCJ ordered it authorized. The Appeals Board adopted the WCJ's Report and Opinion and denied reconsideration.
Issues
Member is $25/month or $250/year and includes full case search.
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.
Holding
Member is $25/month or $250/year and includes full case search.
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.
Analysis
Member is $25/month or $250/year and includes full case search.
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.
Applicant takeaway
Member is $25/month or $250/year and includes full case search.
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.
Defense takeaway
Member is $25/month or $250/year and includes full case search.
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.
Provider takeaway
Member is $25/month or $250/year and includes full case search.
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.
Similar decisions
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.