WCPanelIQ
PanelDenied

Rocha Sanchez, Gonzalo

GONZALO ROCHA SANCHEZ, Applicant vs. HOLLYWOOD REFINISHING, INC.; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ12466711
Decision date
Mar 23, 2023
District office
Van Nuys
WCJ
Jiblet Croft
Claim administrator
State Compensation Insurance Fund
Commissioners
—

Injury / body parts: head, nose, right shoulder

CCR §9792.9.1

Summary

Applicant, a laborer, sustained an industrial injury on August 5, 2019 to his head, nose, and right shoulder. Treating physician Dr. Sangnil submitted an expedited RFA dated November 8, 2022 for an Outpatient Transitional Living Center Day Treatment Program with transportation and Spanish interpreter. Genex issued a November 9, 2022 letter declining to conduct the review on an expedited basis, then performed a UR denial on November 12, 2022. The WCJ found the UR was untimely because the request was not handled on an expedited basis and there was no evidence the November 9 letter was actually transmitted to Dr. Sangnil, and further found substantial medical evidence supported the requested treatment. The WCAB adopted the WCJ's report and denied defendant's Petition for Reconsideration.

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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