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PanelDenied

Melero, Ramona

RAMONA MELERO, Applicant vs. DOROTHY SHEA ENDEAVORS; ALLIANZ RESOLUTION MANAGEMENT, administered by ESIS, Defendants

ADJ number: ADJ3937799
Decision date: Nov 6, 2025
District office: Santa Barbara
WCJ: —
Claim administrator: ESIS (administering Allianz Resolution Management)
Commissioners: JOSEPH V. CAPURRO, COMMISSIONER, CRAIG L. SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER

LC §112LC §115LC §5301LC §5901LC §5908.5LC §5950LC §5906LC §5908LC §5315LC §5701LC §5911LC §5951LC §5909LC §5952LC §5953LC §4709LC §5502LC §110LC §111CCR §10320CCR §10330CCR §10961CCR §10962CCR §10995CCR §10205CCR §10205.4CCR §9792.9.1CCR §9792.6.1CCR §10109

Summary

Applicant Ramona Melero sustained an industrial injury resolved by Stipulated Findings and Award with future medical care. Her primary treater, Dr. Moelleken, submitted an RFA for 23 hours per week of home/attendant care. Defendant delayed UR to obtain additional information (specifically the number of weeks of care required) and ultimately denied the request, which was upheld by IMR. The WCJ found UR was timely under Dubon, and the Appeals Board, after first addressing equitable tolling because the case file was not transmitted within 60 days due to administrative error, affirmed the F&O, holding defendant timely conducted UR within the 14-day delay window and that applicant produced no evidence that the delay was improper.

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.

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.