Francisco Hernandez — ADJ13071035

Francisco Hernandez, an ironworker, fell 20-30 feet in 2019 sustaining catastrophic injuries resulting in 100% permanent total disability and ongoing inpatient rehabilitation at Casa Colina. Defendant Old Republic, administered by Gallagher Bassett, conducted untimely utilization review of a concurrent review request and repeatedly denied payment for authorized inpatient rehabilitation care through bill review over a roughly 10-month period. The WCJ found the UR untimely, the care medically necessary, the services subject to a PPO (Multiplan) contract rather than OMFS, and awarded penalties and interest under section 4603.2, a $10,000 penalty under section 5814, attorney's fees, and section 5813 sanctions in the form of lien claimant attorney's fees. Both defendant and lien claimant sought reconsideration. The Appeals Board adopted the WCJ's Report and granted reconsideration solely to correct a typographical error in the attorney's fee award ($10,800) and to amend Finding 14 to find one additional bill untimely and subject to penalty, otherwise affirming the F&A.