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PanelMed-legalDenied

Sara Villegas — ADJ352576

SARA VILLEGAS, Applicant vs. CALIFORNIA ELWYN INSTITUTE; ZENITH INSURANCE COMPANY, Defendants

ADJ number: ADJ352576
Decision date: Aug 22, 2021
District office: Marina Del Rey
WCJ: Jacqueline A. Walker
Claim administrator: Zenith Insurance Company
Commissioners: —

Injury / body parts: back, psyche

LC §4610

Summary

Applicant Sara Villegas sustained a 2002 industrial injury to her back and psyche while working for the California Elwyn Institute. A 2006 Stipulated Award contained handwritten language providing that medical treatment disputes would be resolved 'per AME reports of Doctors Sohn and Griels only,' which a 2017 Findings of Fact construed as a contract bypassing the IMR/UR process in favor of the orthopedic AME (Dr. Sohn) and psychiatric AME (Dr. Greils) 'as appropriate.' After Dr. Sohn (orthopedic AME) died, the WCJ found that non-psychiatric treatment disputes must now proceed through the standard Labor Code section 4610 UR/IMR process, while psychiatric disputes could still bypass IMR to Dr. Greils. Applicant petitioned for reconsideration arguing improper framing of issues, denial of due process, and that Dr. Greils could review all treatment disputes regardless of specialty. The Board denied reconsideration, adopting the WCJ's report, noting Dr. Greils himself admitted that orthopedic/pain management treatment was outside his area of expertise.

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.