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PanelLienGranted in Part

Carlos Hernandez — ADJ8380057

CARLOS HERNANDEZ, Applicant vs. WATTRANS; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, on behalf of CASTLEPOINT NATIONAL INSURANCE COMPANY, in liquidation; SEDGWICK, Defendants

ADJ number: ADJ8380057
Decision date: Mar 2, 2023
District office: Los Angeles
WCJ: —
Claim administrator: Sedgwick CMS on behalf of California Insurance Guarantee Association (CIGA), for Castlepoint National Insurance Company, in liquidation
Commissioners: JOSÉ H. RAZO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: left knee, scalp, neck, back, left lower extremity, dental, TMJ

Summary

Applicant Carlos Hernandez sustained an industrial injury on May 9, 2012, while working as a truck driver for Wattrans. A March 25, 2021 Findings and Award disallowed the lien of Pain Management Care as not reasonably necessary but ordered reimbursement to Dental Trauma Center, including penalty and interest. Defendant CIGA sought reconsideration as to the Dental Trauma Center award, arguing the reports were not incorporated by the treating physician, were not properly or timely requested, and were not reasonable and necessary. After the Board granted reconsideration, the parties participated in a commissioners' settlement conference and reached a stipulation to settle the Dental Trauma Center lien (balance $6,693.63) for $3,000. The Board rescinded the WCJ's decision, disallowed the Pain Management Care lien, and approved the Dental Trauma Center settlement stipulation.

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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Similar decisions

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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.

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.

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.

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.