WCPanelIQ
PanelMed-legalDenied

Abiel Harrison — ADJ9924960

ABIEL HARRISON, Applicant vs. CANYON SPRINGS POOLS AND SPAS, INC.; STATE COMPENSATION INSURANCE FUND, Defendants

ADJ number
ADJ9924960
Decision date
Aug 29, 2021
District office
Van Nuys
WCJ
—
Claim administrator
State Compensation Insurance Fund
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, MARGUERITE SWEENEY, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: cervical spine, lumbar spine, both shoulders, both knees, both feet

LC §4660.1LC §5001LC §5803LC §5804LC §5903LC §5904LC §5952CCR §10700CCR §10843CCR §10882CCR §10955

Summary

Applicant Abiel Harrison and State Compensation Insurance Fund (SCIF) entered a January 8, 2020 Compromise & Release relying on a zero-dollar Medicare Set-Aside (MSA). After CMS demanded reimbursement of $883.82 from Harrison under the Medicare Secondary Payer Act (which Harrison paid out-of-pocket as $909.96 with interest), the WCJ set aside the C&R and rescinded the OACR based on mutual mistake. SCIF petitioned for reconsideration, arguing there was no mutual mistake because the parties never intended to submit the MSA to CMS, and that the CMS letter (Applicant's 6) should not have been admitted. The Board treated the petition under the removal standard because SCIF challenged only the interlocutory good-cause finding, found no significant prejudice or irreparable harm, and denied the petition, adopting the WCJ's report and agreeing good cause existed to set aside the OACR due to mutual mistake.

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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