PanelQMEGranted
Clara Goldassio — ADJ14305554
CLARA GOLDASSIO, Applicant vs. WALMART, INC.; ACE AMERICAN INSURANCE COMPANY, Defendants
- ADJ number
- ADJ14305554
- Decision date
- Jun 8, 2026
- District office
- Santa Rosa
- WCJ
- —
- Claim administrator
- ACE American Insurance Company
- Commissioners
- KATHERINE WILLIAMS DODD, COMMISSIONER, PAUL F. KELLY, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER
Injury / body parts: neck, bilateral shoulders, back, bilateral wrists, left shoulder, left biceps
LC §4600LC §4604LC §4604.5LC §4610LC §4610.5LC §5300LC §5301LC §5304LC §5307.27LC §5703LC §5900LC §5909CCR §35.5CCR §9792.9.1CCR §9792.9.6CCR §9792.20CCR §9792.21CCR §9792.27.23
Summary
Applicant Clara Goldassio sought reconsideration of a March 4, 2026 F&O in which the WCJ dismissed as untimely her request for court review of a December 3, 2024 UR determination non-certifying left shoulder total replacement and biceps tenotomy surgery. The Board found the WCJ erred: the UR determination was in fact untimely under Labor Code section 4610(i) and former AD Rule 9792.9.1(f) because there was no evidence the reviewer requested missing information or made a timely determination within five business days of the November 22, 2024 RFA. The Board rejected the WCJ's conclusion that he lacked jurisdiction, holding that under Dubon II the WCAB must determine medical necessity when UR is untimely. The Board also found the WCJ improperly declined to admit applicant's treating physician reports without identifying any objection. The Board granted reconsideration, rescinded the F&O, and returned the matter to the trial level for development of the record and a determination of medical necessity.
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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