What the panel ordered
Petition for Reconsideration dismissed; Petition for Removal granted; WCJ decision of 2020-11-24 rescinded and matter returned to WCJ for further proceedings
Petition for Reconsideration dismissed; Petition for Removal granted; WCJ decision of 2020-11-24 rescinded and matter returned to WCJ for further proceedings
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The WCAB found the WCJ's decision was interlocutory and not final, dismissing reconsideration but granting removal to allow further proceedings on the timeliness and reasonableness of the UR denial.
From the decision · page 2Here, the WCJ's decision solely resolves an intermediate procedural or evidentiary issue or issues. The decision does not determine any substantive right or liability and does not determine a threshold issue. Accordingly, it is not a "final" decision and the petition will be dismissed to the extent it seeks reconsideration.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The WCJ's decision resolved an intermediate procedural or evidentiary issue and did not determine any substantive right or liability.
Favours Defendant prevailed
This meant the decision was not final and the petition for reconsideration was dismissed.
From the decision · page 2Here, the WCJ's decision solely resolves an intermediate procedural or evidentiary issue or issues. The decision does not determine any substantive right or liability and does not determine a threshold issue. Accordingly, it is not a "final" decision and the petition will be dismissed to the extent it seeks reconsideration.
The WCAB granted the petition for removal, rescinded the WCJ's decision, and returned the matter to the WCJ for further proceedings.
Favours Applicant prevailed
This allowed the issues involving the Utilization Review and treatment requested by Dr. Jerrold Bustos to be re-determined.
From the decision · page 2Nevertheless, for the reasons stated in the WCJ's report, we will grant the petition to the extent it seeks removal, rescind the WCJ's decision, and return this matter to the WCJ for further proceedings and decision.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Provided multiple medical reports relevant to the injury and treatment issues.
From the decision · page 5The parties jointly placed into evidence the medical reports of Panel Qualified Medical Examiner Dr. James Coleman dated April 24, 2020, December 4, 2018 and September 10, 2019.
Provided treating doctor reports and request for authorization reports relevant to the injury and treatment issues.
From the decision · page 5Applicant placed into evidence, without objection, the treating doctor reports from Dr. David Auerbach, request for authorization report and medical reports from Dr. Jerrold Bustos, records from Kaiser and Healthline Medical, nurse's notes and correspondence from Applicant's Attorney and from claims. All exhibits offered by Applicant were entered into evidence without objection.
Provided medical reports relevant to the injury and treatment issues, including a UR denial letter that was excluded from evidence.
From the decision · page 5Applicant placed into evidence, without objection, the treating doctor reports from Dr. David Auerbach, request for authorization report and medical reports from Dr. Jerrold Bustos, records from Kaiser and Healthline Medical, nurse's notes and correspondence from Applicant's Attorney and from claims. All exhibits offered by Applicant were entered into evidence without objection.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 5900(a), 5902, 5903
A petition for reconsideration may only be taken from a final order, decision, or award.
The WCAB dismissed the petition for reconsideration because the WCJ's decision was interlocutory and not final.
From the decision · page 1A petition for reconsideration may properly be taken only from a "final" order, decision, or award. (Lab. Code, § 5900(a), 5902, 5903.) A "final" order has been defined as one that either "determines any substantive right or liability of those involved in the case" (Rymer v. Hagler (1989) 211 Cal.App.3d 1171, 1180; Safeway Stores, Inc. v. Workers' Comp. Appeals Bd. (Pointer) (1980) 104 Cal.App.3d 528, 534-535 [45 Cal.Comp.Cases 410]; Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Kramer) (1978) 82 Cal.App.3d 39, 45 [43 Cal.Comp.Cases 661]) or determines a "threshold" issue that is fundamental to the claim for benefits. (Maranian v. Workers' Comp. Appeals Bd. (2000) 81 Cal.App.4th 1068, 1070, 1075 [65 Cal.Comp.Cases 650].) Interlocutory procedural or evidentiary decisions, entered in the midst of the workers' compensation proceedings, are not considered "final" orders. (Id. at p. 1075 ["interim orders, which do not decide a threshold issue, such as intermediate procedural or evidentiary decisions,
What proof carried it
The evidence the panel weighed, by kind.
Exclusion of the UR denial letter from evidence and determination that the UR denial was untimely
From the decision · page 5Defendants are aggrieved by determination that the UR denial letter to Dr. Jerrold Bustos was excluded from evidence. Also, Defendant are agreed by determination that the Utilization Review denial was untimely and excluded from evidence.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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