WCPanelIQ
PanelMed-legalRemanded

Josue Sanchez — ADJ19725418

JOSUE SANCHEZ, Applicant vs. ALF WINDOW COVERINGS, LLC; TECHNOLOGY INSURANCE, administered by AMTRUST, Defendants

ADJ number
ADJ19725418
Decision date
Jul 5, 2026
District office
Riverside
WCJ
—
Claim administrator
AmTrust (Technology Insurance Company; also referenced as Amtrust Concord)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG L. SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: head, right ear, dizziness, memory loss, headaches, tinnitus

LC §4600LC §4603.2LC §4610LC §4616LC §4616.3LC §4906LC §5313LC §5705LC §5900LC §5904LC §5909CCR §9767.5CCR §9767.5.1CCR §9767.6CCR §9785CCR §9792.6.1CCR §9792.9.3CCR §10600CCR §10787CCR §10803CCR §10955

Summary

Josue Sanchez sustained an admitted head injury (with dizziness, memory loss, headaches, and tinnitus) while working as an installer for Alf Window Coverings on May 2, 2024. After a series of expedited hearings involving whether he could treat outside defendant's MPN for brain rehabilitation (particularly at Casa Colina) and disputes over deferred/untimely UR, the WCJ issued a March 19, 2026 F&O finding it premature to determine out-of-MPN treatment, that MPN searches are measured from applicant's residence per Rule 9767.5(a), that applicant need not use the Medical Access Assistant, and ordering defendant to conduct retrospective UR of a treatment request addressed in a November 6, 2024 UR deferral letter. Both parties sought reconsideration/removal. The Board found the evidentiary record hopelessly muddled—the RFA ordered to be reviewed was not in evidence, the issues were poorly framed, and retrospective review was likely inappropriate. The Board granted both petitions, rescinded the F&O, substituted a Findings of Fact establishing only injury AOE/COE, and returned the matter to the WCJ for further proceedings with clearly stated issues and a developed record.

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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