PanelRemanded
Jose Ybarguen — ADJ11235520
JOSE YBARGUEN, Applicant vs. UNITY COURIER SERVICE, INC.; REDWOOD FIRE AND CASUALTY INSURANCE COMPANY, administered by BERKSHIRE HATHAWAY HOMESTATE COMPANIES, Defendants
- ADJ number
- ADJ11235520
- Decision date
- Jun 21, 2026
- District office
- Anaheim
- WCJ
- —
- Claim administrator
- Berkshire Hathaway Homestate Companies (administering Redwood Fire and Casualty Insurance Company)
- Commissioners
- PATRICIA A. GARCIA, DEPUTY COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, CRAIG L. SNELLINGS, COMMISSIONER
Injury / body parts: head, mouth, neck, left wrist, right elbow
LC §4610LC §5502LC §5701LC §5906CCR §9792.9.1
Summary
Applicant Jose Ybarguen sustained an industrial injury on January 11, 2018 to his head, mouth, neck, left wrist, and right elbow while working as a delivery courier. His treating physician, Dr. Bertoldi, submitted an RFA for an inpatient traumatic brain injury evaluation at Casa Colina Apple Valley, which defendant subjected to a June 6, 2022 request for additional information and a June 10, 2022 UR modification/denial. The WCJ found the UR timely and that the WCAB lacked jurisdiction over the treatment dispute. On reconsideration, the Board found the expedited review provisions inapplicable but determined the record contained a material evidentiary gap regarding whether defendant timely and properly communicated its June 6, 2022 request for additional information needed to toll the five-business-day standard review period. The Board rescinded the WCJ's F&F and remanded for further development of the record on the timeliness/communication issue.
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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