What the panel ordered
Defendant's Petition for Reconsideration of the May 8, 2025 Findings of Fact and Orders is granted; final decision after reconsideration is deferred pending further review of the merits and the entire record.
Defendant sought removal of the WCJ's Findings of Fact and Orders issued May 8, 2025, challenging the order to provide medical treatment; the WCJ issued a Report and Recommendation to deny reconsideration; the WCAB granted defendant's Petition for Reconsideration and deferred final decision pending further review.
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 WCJ found the UR denial dated April 15, 2025 was untimely because the defendant had the requested information from prior RFAs, thus WCAB has jurisdiction to determine medical necessity. Defendant challenged this finding, arguing the RFA was new and the denial was timely. The WCAB granted reconsideration to further study the issue of change in circumstances.
From the decision · page 1Defendant seeks removal in response to the Findings of Fact and Orders (F&O) issued on May 8, 2025, wherein the workers' compensation administrative law judge (WCJ) found in pertinent part that while employed during the period July 21, 1995 through March 23, 2020, as a Correctional Officer by defendant Corcoran State Prison, applicant sustained injury arising out of and in the course of employment to the neck, the back, and the ears (hearing loss). The WCJ further found that the Request for Authorization (UR) was received by carrier on April 1, 2025; that defendant and EK Health were served with the medical information requested on two occasions prior to the denial letter of April 15, 2025; and that the denial dated April 15, 2025 was untimely (Cal. Code Regs., tit. 8, § 9792.1.9 (e) (5) (F)). He ordered defendant to provide medical treatment in accordance with the RFA issued by Dr. Rasouli dated April 15, 2025.