WCPanelIQ
PanelLienGranted

Leon, Maricela

MARICELA LEON, Applicant vs. ADVANCE BUILDING MAINTENANCE INC.; SECURITY NATIONAL INSURANCE COMPANY; Adjusted by AMTRUST CONCORD, Defendants

ADJ number
ADJ15513907
Decision date
Apr 11, 2023
District office
Redding
WCJ
—
Claim administrator
AmTrust Concord (adjusting for Security National Insurance Company)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER
LC §4600LC §4610LC §4062LC §4610.5CCR §9792.9.1

Summary

Applicant Maricela Leon sought reconsideration of a February 8, 2023 Findings of Fact in which the WCJ found the WCAB lacked jurisdiction over the reasonableness of medical treatment because the December 7, 2022 UR determination was timely. Applicant argued the UR decision was untimely because it was not served on applicant's counsel within two business days as required by CCR section 9792.9.1(e)(3). The Board found the WCJ analyzed only whether the UR was timely made but failed to address whether it was timely communicated, as required under Bodam. Because a UR decision that is timely made but not timely communicated is untimely, and because the defendant bears the burden of proving timeliness, the Board granted reconsideration, rescinded the Findings of Fact, and remanded for further proceedings and a new decision.

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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