WCPanelIQ
PanelMed-legalLienGranted

Gomez, Crystal

CRYSTAL GOMEZ, Applicant vs. CALIFORNIA INSTITUTION FOR WOMEN, LEGALLY UNINSURED, administered by STATE COMPENSATION INSURANCE FUND, STATE EMPLOYEES, Defendants

ADJ number
ADJ16229232
Decision date
Aug 24, 2025
District office
Riverside District Office
WCJ
—
Claim administrator
State Compensation Insurance Fund (administering for California Institution for Women, legally uninsured)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: psyche, stress/psychiatric

LC §4060LC §4062.2LC §4600LC §5803LC §5900LC §5901LC §5907LC §5908LC §5908.5LC §5909LC §5950CCR §9793CCR §9785.5CCR §10605CCR §10786

Summary

Lien claimant Premier Psychological Services (via Dr. Mark H. Michaels) sought reconsideration of a May 13, 2025 F&O in which the WCJ ordered the lien claimant take nothing because, when services were provided on November 21, 2022, there was no valid request for a medical-legal examination from a proper party under AD Rule 9793(h)(2). The WCJ found the applicant's attorney's Labor Code section 4600 letter was mailed the same day as the date of service (and thus not yet in the provider's possession), and that the letter's request for a comprehensive medical-legal evaluation was conditioned on the applicant being permanent and stationary—a condition the provider's own report showed was not met. Lien claimant argued a contested claim existed after the August 15, 2022 denial and that services were proper under Labor Code section 4060. The Appeals Board granted reconsideration on a preliminary basis to allow full review of the merits, deferring a final decision. The grant addresses the timeliness of Board action under amended section 5909 and the need for further consideration of the entire record.

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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