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PanelLienDenied

Diaz Nevarez, Eleanor

ELEANOR DIAZ NEVAREZ, Applicant vs. ELK GROVE UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured administered by SCHOOLS INSURANCE AUTHORITY, Defendants

ADJ number: ADJ9712319
Decision date: Jun 19, 2025
District office: Sacramento
WCJ: Peter M. Wilkens
Claim administrator: Schools Insurance Authority (administrator for Elk Grove Unified School District, Permissibly Self-Insured)
Commissioners: —

Injury / body parts: right ankle

LC §5909LC §5900LC §4610.5LC §4610.6CCR §10964CCR §10600CCR §9792.9.1

Summary

Applicant Eleanor Diaz Nevarez sustained an admitted right ankle injury on September 25, 2013. The dispute centered on whether utilization review (UR) of an RFA for an H-Wave device, submitted by Dr. Bernhardt and received by defendant on September 11, 2018, was timely. Defendant returned the RFA on September 13, 2018 requesting additional information, claimed the RFA was incomplete under 8 CCR § 9792.9.1(c)(2)(A), and argued no further obligation existed. The WCJ found the RFA was procedurally complete and that defendant's conduct invoked § 9792.9.1(f), which required defendant to issue a denial within 14 days with conditional language allowing reconsideration upon receipt of the information; because defendant failed to do so, the UR was untimely and invalid. The Appeals Board adopted the WCJ's report and denied reconsideration.

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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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.