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PanelGranted

Charlesetta Wiley — ADJ8902701

CHARLESETTA WILEY, Applicant vs. AT&T, administered by SEDGWICK CMS, Defendants

ADJ number: ADJ8902701
Decision date: Aug 15, 2021
District office: Van Nuys
WCJ: —
Claim administrator: Sedgwick CMS
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, KATHERINE WILLIAMS DODD, COMMISSIONER, MARGUERITE SWEENEY, COMMISSIONER

Injury / body parts: cervical spine, bilateral shoulders, bilateral elbows, bilateral carpal tunnel (wrists/hands)

LC §4600LC §4604.5LC §4610LC §4610.5LC §4610.6LC §4062CCR §9792.21CCR §9792.10.5

Summary

Applicant Charlesetta Wiley sought reconsideration of a WCJ's F&O upholding a November 16, 2020 IMR determination that affirmed UR denial of home health care recommended by her PTP, Dr. Rashti. The IMR reviewer never received Nurse Sally Glade's April 2018 in-home assessment, which directly supported the need for home care, because defendant failed to provide it. The Board found clear and convincing evidence that the IMR determination resulted from a plainly erroneous finding of fact (Lab. Code § 4610.6(h)(5)) and was in excess of the AD's powers (§ 4610.6(h)(1)) because defendant failed to provide all material and relevant records under § 4610.5(l)(1). The Board granted reconsideration, rescinded the F&O, found the IMR determination invalid, and remanded the dispute to the AD under § 4610.6(i) for submission to a different IMR organization or reviewer.

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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