ADJ12874605 — California WCAB decision

What the panel ordered

Defendant's Petition for Reconsideration is granted; final decision after reconsideration is deferred pending further review of the merits and entire record.

Defendant sought reconsideration of the October 13, 2025 Findings and Award regarding compensable consequences and treatment requests; the WCJ issued a Report recommending denial; the Appeals Board granted reconsideration and deferred final decision pending further review.

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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.

Medical treatment / UR / IMRRemandedurinary system · gastro-intestinal system · wheelchair access · home modifications · wheelchair transportation

The Appeals Board found that the record was not properly developed on the disputed issues due to changes in applicant's condition and location, requiring further development and reconsideration.

From the decision · page 7III. Although we have preliminarily considered the Petition for Reconsideration, the Answers thereto, and the WCJ's Report, and the record in this matter, we are not persuaded that the record is properly developed on the disputed issues raised in the petition. As contended in defendant's Petition, applicant's location, condition, and even the evidence in this case have been subject to change over the more than one and a half years since Dr. Sangnil recommended the currently disputed items of treatment. Accordingly, taking into account the statutory time constraints for acting on the Petition, and based upon our initial review of the record, we believe reconsideration must be granted to allow sufficient opportunity to further study how the facts of this case apply to unaddressed and developing legal issues, and to ensure that the parties are afforded due process. Thereafter, a final decision after reconsideration will be issued by the Appeals Board, from which any aggrieved person may timely seek a writ of review pursuant to section 5950 et seq.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant is seriously impaired, wheelchair bound, and suffers from functional quadriplegia as noted by physicians and applicant's testimony.

Favours Applicant prevailed

Supports the need for treatment requests including wheelchair access assessment, home modifications evaluation, and wheelchair transportation.

From the decision · page 4the applicant is seriously impaired. She can attempt to ambulate with a walker as she testified. But she suffers from weakness and pain. As stated above, both QME's have noted that she is wheelchair bound. A year ago, she was not able to leave the inpatient care due to her inability to ambulate. The physicians seem to be in agreement that she suffers from "functional quadriplegia."

No evidence of significant improvement in applicant's condition after returning from Alabama.

Favours Applicant prevailed

Undermines defendant's argument that treatment requests are no longer necessary due to improvement.

From the decision · page 4Defendant maintains that since returning from Alabama it seems that there is some improvement in her condition. However, this is not reflected anywhere in the medical reports that were in evidence.

Defendant failed to provide timely utilization review (UR) of Dr. Sangnil's June 21, 2024 Request for Authorization (RFA).

Favours Applicant prevailed

This failure gave the WCJ jurisdiction to determine the medical necessity of the disputed treatment items.

From the decision · page 7In this case, the WCJ, like the WCJ in Omurang, has jurisdiction over the disputed issue of wheelchair transportation, as well as evaluations for possible home modifications including wheelchair access, because of defendant's failure to provide a timely UR in response to Dr. Sangnil's June 21, 2024 RFA. We note that this exercise of jurisdiction under Dubon II does not absolve the WCJ of the duty to apply the provisions of the MTUS, set forth in AD Rules § 9792.20 through 9792.27.23, to each disputed item of treatment.

Record is not properly developed on disputed issues due to changes in applicant's condition and location over time.

Favours neutral

Requires further development and reconsideration to ensure due process and accurate decision-making.

From the decision · page 7III. Although we have preliminarily considered the Petition for Reconsideration, the Answers thereto, and the WCJ's Report, and the record in this matter, we are not persuaded that the record is properly developed on the disputed issues raised in the petition. As contended in defendant's Petition, applicant's location, condition, and even the evidence in this case have been subject to change over the more than one and a half years since Dr. Sangnil recommended the currently disputed items of treatment. Accordingly, taking into account the statutory time constraints for acting on the Petition, and based upon our initial review of the record, we believe reconsideration must be granted to allow sufficient opportunity to further study how the facts of this case apply to unaddressed and developing legal issues, and to ensure that the parties are afforded due process. Thereafter, a final decision after reconsideration will be issued by the Appeals Board, from which any aggrieved person may timely seek a writ of review pursuant to section 5950 et seq.

ADJ12874605 · January 13, 2026

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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