Avila, Teresa

Applicant Teresa Avila sustained an industrial lumbar spine injury (awarded medical treatment in a 2007 Stipulated Award, case resolved by C&R in 2017). Lien claimant Sleep Treatment Clinic provided an Obstructive Airway Oral Appliance and related treatment after applicant's PTP and the lien claimant submitted RFAs concerning insomnia and sleep-disordered breathing related to the lumbar injury. The WCJ found the treatment reasonably required under Labor Code section 4600, that defendant failed to timely respond to or defer utilization review on multiple RFAs (including an emergency RFA), that the section 4903.05(c) declaration was not false, and that the record needed development on the reasonableness of charges. State Compensation Insurance Fund sought reconsideration arguing no substantial evidence of an industrial sleep injury, no reasonable/necessary treatment, a false declaration, and lack of a valid PTP RFA. The Appeals Board denied reconsideration, holding defendant waived objections by ignoring RFAs and failing to investigate or control care, thereby becoming liable for self-procured treatment.