JESUS CERVANTES, Applicant vs. EL AGUILA FOOD PRODUCTS, INC.; SAFECO INSURANCE CO. OF ILLINOIS; SUPERIOR NATIONAL INSURANCE CO., In Liquidation; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION; and BROADSPIRE (Servicing Facility), Defendant(s).
ADJ number
—
Decision date
Date unavailable
District office
Salinas
WCJ
—
Claim administrator
Broadspire (Servicing Facility); Safeco Insurance Company of Illinois; California Insurance Guarantee Association
Applicant Jesus Cervantes sustained industrial low back injuries while employed by El Aguila Food Products. His treating physician, Dr. Dureza, recommended lumbar fusion surgery, which Safeco's utilization review (UR) physician denied as not medically necessary. The WCJ found applicant entitled to surgery, deeming the legal procedural issues moot. On reconsideration en banc, the Board addressed the proper procedure when a treating physician recommends spinal surgery, holding that the defendant must conduct UR, and if UR denies the surgery, the defendant (not the employee) must timely object under section 4062(b) within 10 days. The Board expressly disapproved Brasher to the extent it allowed defendants to bypass UR and placed the objection burden on the employee. The Board rescinded the WCJ's order and remanded, giving Safeco 10 days to object because its prior reliance on Brasher was reasonable.
Issues
Member is $25/month or $250/year and includes full case search.
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.
Holding
Member is $25/month or $250/year and includes full case search.
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.
Analysis
Member is $25/month or $250/year and includes full case search.
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.
Applicant takeaway
Member is $25/month or $250/year and includes full case search.
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.
Defense takeaway
Member is $25/month or $250/year and includes full case search.
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.
Provider takeaway
Member is $25/month or $250/year and includes full case search.
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.
Similar decisions
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.
Member is $25/month or $250/year. Subscribe to view similar decisions.
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.