LYNNE SHAW, Applicant vs. AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA; HARTFORD INSURANCE, Defendants
ADJ number
ADJ8996318
Decision date
Jul 2, 2023
District office
San Diego
WCJ
—
Claim administrator
Hartford Insurance
Commissioners
—
Injury / body parts: cervical spine, bilateral wrists, right knee, lower extremities (gait disorder), psyche/adjustment disorder
LC §4610LC §4062CCR §9792.9.1CCR §9792.9
Summary
Applicant Lynne Shaw suffered an admitted industrial injury to her cervical spine and bilateral wrists. Her primary treating physician requested treatment (an orthotic/AFO evaluation and a mobility scooter) for a right knee/gait disorder, claiming it was a compensable consequence of her cervical spine injury. Defendant Automobile Club of Southern California issued two Notices of Deferred RFA, asserting the body parts were non-industrial and the requested treatment was not medically necessary, and argued the matter should go to utilization review. The WCJ found the WCAB had jurisdiction and that the treatment was reasonable, necessary, and a compensable consequence of the industrial injury. On reconsideration, the WCAB granted defendant's petition only to amend Finding No. 1 to state that defendant did NOT timely defer utilization review because the deferral notices were not served on the applicant, otherwise affirming the WCJ's findings on compensability and medical necessity.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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