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PanelDenied

Oscar Quinones — ADJ12994937

OSCAR QUINONES, Applicant vs. CORONA AUTO PARTS RECYCLING; STAR INSURANCE COMPANY; administered by MEADOWBROOK INSURANCE, Defendants

ADJ number: ADJ12994937
Decision date: Dec 26, 2021
District office: Riverside
WCJ: Jeffrey Wilson
Claim administrator: Meadowbrook Insurance (administering for Star Insurance Company); AmeriTrust
Commissioners: —

Injury / body parts: low back

LC §4610CCR §9792.6.1CCR §9792.9.1

Summary

Applicant Oscar Quinones, a 56-year-old driver, sustained a low back injury on November 15, 2017. His treating physician Dr. Hannani issued RFAs in February and March 2021 recommending L4-5 and L3-4 decompression surgery and related care. Applicant's counsel faxed the RFAs on April 5, 2021 to a general organization fax number rather than the specific UR fax number (855-603-8407) that defendant had designated in an April 21, 2020 communication. The WCJ found, and the Board agreed, that because the RFA was not faxed to the designated UR fax number, the UR process was not properly initiated on April 5, and defendant's April 19, 2021 UR denial was therefore not untimely. The Board denied the Petition for Reconsideration, adopting and incorporating the WCJ's report.

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.