ADJ292246 · July 1, 2026

The WCAB concluded that the request for a motorized wheelchair is a new and different treatment subject to utilization review, so the WCAB lacks jurisdiction to decide its medical necessity at this time.

From the decision · page 4Under California's workers' compensation system, questions relating to the medical necessity of a treatment requested by a physician are decided through a compulsory UR process. Section 4610 requires that employers establish a UR process and once a treating physician submits an RFA to an employer, the employer must either approve the treatment request or dispute the treatment request and submit the matter for review by a UR physician who then must determine, based on "medical necessity," whether to approve, modify, or deny the requested treatment. (§ 4610; State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 241.)

The petition for reconsideration was dismissed as untimely because the Appeals Board must act within 60 days of case transmission, and the petition was filed after this period.

From the decision · page 2Under section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board. Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS). Specifically, in Case Events, under Event Description is the phrase "Sent to Recon" and under Additional Information is the phrase "The case is sent to the Recon board."

The petition for reconsideration was filed on February 23, 2026, after the 60-day period from case transmission on May 19, 2026, had expired.

Favours Defendant prevailed

This made the petition untimely and subject to dismissal.

From the decision · page 22 The petition for reconsideration of the Joint Findings of Fact indicates that applicant did not review that decision until February 17, 2026. The petition for reconsideration of the Joint Findings of Fact was not filed until February 23, 2026. 3 WCAB Rule 10600(b) (Cal. Code Regs., tit. 8, § 10600(b)) states:

The request for a motorized wheelchair is a new and different treatment subject to utilization review, not previously authorized as a modification of a manual wheelchair.

Favours Defendant prevailed

This placed the issue outside the WCAB's jurisdiction to decide medical necessity at this time.

From the decision · page 4Here, defendant authorized motorized wheels for applicant's manual wheelchair because applicant had non-industrial disabilities that sometimes required her to use a manual wheelchair and her industrial injury to the upper extremities made her unable to use it. (Opinion and Order Dismissing Petition for Reconsideration, May 7, 2026, p. 2.) The request before us, however, seeks a motorized wheelchair or "scooter" rather than modification of a manual wheelchair. It follows that the request is for a new and different treatment; and, as such, is subject to UR.

Labor Code section 5909

A petition for reconsideration must be acted upon by the Appeals Board within 60 days from the date a trial judge transmits a case to the Appeals Board.

The petition was dismissed as untimely because the Appeals Board did not act within 60 days of transmission.

From the decision · page 2Under section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board. Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS). Specifically, in Case Events, under Event Description is the phrase "Sent to Recon" and under Additional Information is the phrase "The case is sent to the Recon board."

Labor Code section 4610

Employers must establish a utilization review (UR) process to determine medical necessity of treatment requests by physicians.

The request for a motorized wheelchair is subject to UR and not within the WCAB's jurisdiction to decide medical necessity.

From the decision · page 4Under California's workers' compensation system, questions relating to the medical necessity of a treatment requested by a physician are decided through a compulsory UR process. Section 4610 requires that employers establish a UR process and once a treating physician submits an RFA to an employer, the employer must either approve the treatment request or dispute the treatment request and submit the matter for review by a UR physician who then must determine, based on "medical necessity," whether to approve, modify, or deny the requested treatment. (§ 4610; State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 241.)

Applicant was traveling outside the country and unable to review the Joint Findings of Fact until February 17, 2026, which she contended tolled the time for filing the petition for reconsideration.

From the decision · page 3Applicant contends that the petition for reconsideration should be deemed timely because she was traveling outside the country and unable to review the Joint Findings of Fact until February 17, 2026. Specifically, applicant argues that the time for filing the petition is tolled because she advised the WCJ of the dates of her travel and consulted with the Information & Assistance (I&A) officer about her inability to respond to a decision by the WCJ while traveling.