ELENO PEREZ, Applicant vs. S Q & SON LABOR SERVICE; STATE COMPENSATION INSURANCE FUND, Defendants
ADJ number
ADJ2278057
Decision date
Sep 10, 2023
District office
Oxnard
WCJ
Michael K. Greenberg
Claim administrator
State Compensation Insurance Fund
Commissioners
—
Injury / body parts: heart, right elbow, left foot, lower back, right lower leg, psyche, shoulders, right knee, mouth, teeth, head, arm, foot, circulatory system, digestive system, abdomen, left ankle, right upper arm
LC §4603.2LC §4062CCR §9792.21.1CCR §9792.25.1
Summary
Lien claimant The Dental Trauma Center sought reimbursement of $14,438.94 for two dates of service (7/13/2016 and 7/25/2016) related to dental treatment for an applicant injured in a 2006 forklift accident who developed bruxism and fractured teeth as a compensable consequence of his orthopedic, internal, and psychiatric injuries. The WCJ found the dental treatment (except for sleep-related treatment) industrial and reasonable, awarding reimbursement with statutory increase and interest, but disallowed reimbursement for an obstructive airway oral appliance because the prescribing dentist was not licensed to diagnose sleep apnea. The lien claimant petitioned for reconsideration challenging the disallowance of the oral appliance and the WCJ's reliance on a reimbursement guide and a claims adjuster's declaration. A three-commissioner panel denied reconsideration, adopting and incorporating the WCJ's Report and Recommendation. The petition was also procedurally defective because it sought reconsideration of the Opinion on Decision rather than the actual Findings, Award and Order.
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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