What the panel treated as outcome-determinative, and which side it favoured.
Applicant failed to provide credible or substantial evidence to prove the need for a service dog on an industrial medical basis for her neck and bilateral shoulder injury.
Favours Defendant prevailed
This failure led to denial of the claim for service dog medical necessity.
From the decision · page 9Applicant referenced some documents in her Petition for Reconsideration that she believed
showed that she needed a service dog on a medical basis for her industrial injury. One document
was identified on page 7 of the Petition for Reconsideration as a "2011 PTP order for a service
dog" (Applicant's Exhibit 65, page 44). This document appears to be a prescription from Coast
Pain Management with an illegible date. It stated "Pt requires service dog due to the applicant
having significant functional limitations." After reviewing all the evidence, the Workers'
Compensation Administrative Law Judge "WCJ" noted that there was no Request for
Authorization form or RFAs in the exhibits by a treating physician requesting that Applicant be
provided with a service dog for her industrial injury. There was no medical report in evidence that
constituted substantial medical evidence that outlined why a service dog would be needed on an
industrial medical basis for Applicant's bilateral shoulder and neck injury. For the above reasons,
Applicant did not meet her burden of showing that her service dogs were needed on a medical
basis for her industrial injury to her neck and bilateral shoulders.
Applicant did not identify any specific late mileage reimbursement request or prove entitlement to a penalty for late reimbursement.
Favours Defendant prevailed
This lack of proof led to denial of the penalty claim for late mileage reimbursement.
From the decision · page 10Applicant did not meet her burden of showing that she should be awarded a penalty on late
mileage for treatment for her neck and bilateral shoulders. She did not identify any particular
mileage reimbursement request that was late. She did not indicate when they were sent to
Defendant or when she received payment. Teri Thompson, program coordinator for the City of
San Diego and current adjuster for Applicant's claim, credibly testified that she had issues with
Applicant's mileage reimbursement requests. The issues varied but sometimes the requests were
not legible, or had dates of service that were cut off, or were requesting mileage for treatment for
body parts that were not industrial body parts, or were requesting mileage where the location where
treatment occurred was not clear. When problems with mileage requests were noted, applicant
would receive in writing why there was a problem with her mileage requests (May 22, 2025
Summary of Evidence, page 2, lines 10-22). For the reasons stated above, applicant did not meet
her burden of showing that she should be awarded a penalty for late mileage reimbursement.
Applicant failed to produce credible evidence that defendant withheld medical reports prior to February 8, 2016, or that any withheld records would have affected the prior trial outcome.
Favours Defendant prevailed
This failure led to denial of the claim regarding withholding of medical reports.
From the decision · page 10Applicant failed to produce any credible evidence that Defendant withheld medical reports
that were in their possession prior to February 8, 2016 but were not served until after the trial with
Judge Ellison was completed. Nor has she shown that any alleged withheld records would have
made a difference in the outcome of her trial with Judge Ellison.