ADJ7404188 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; prior Findings and Order rescinded; new Findings of Fact substituted finding contested claim existed; matter returned to trial level for further proceedings.

Petition for reconsideration of Findings and Order issued by WCJ on November 25, 2025, granted by WCAB panel on March 2, 2026, rescinding the prior Findings and Order and returning matter to trial level for further proceedings.

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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 / IMRApplicant prevailedlow back · psych

The WCAB found that a contested claim existed at the time the medical-legal copy services were provided, contrary to the WCJ's finding that the claim was not contested because the low back injury was accepted and the psych claim was subject to the six-month rule. The WCAB emphasized that the denial of the psych claim and the nature of the Compromise & Release settlement showed the claim was contested, thus entitling cost petitioner to reimbursement.

From the decision · page 7contested claim that would entitle it to medical-legal reimbursement under sections 4620 and 4621, and the Colamonico en banc decision. In his Opinion, the WCJ states that the claim was not contested because defendant accepted applicant's claim of injury to the low back and the claim of psych was subject to the six-month rule. We disagree.

The facts that decided it

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

Defendant denied liability for applicant's psych injury claim, never paying benefits for that body part.

Favours Applicant prevailed

This denial established that a contested claim existed at the time the medical-legal copy services were provided, supporting cost petitioner's entitlement to reimbursement.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

The Compromise & Release settlement and Order Approving C&R explicitly stated that liability was accepted only for the low back injury, indicating other body parts were contested.

Favours Applicant prevailed

This showed that the claim was contested, contrary to the WCJ's finding, and supported the cost petitioner's claim for reimbursement.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Applicant prevailed

Defendant's denial of applicant's claim for psych injury shows the claim was contested as defendant never paid benefits for that body part.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

Documentary evidencefavours Applicant prevailed

The Compromise & Release settlement and Order Approving C&R show that liability was only accepted for the low back, indicating a contested claim for other body parts.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

ADJ7404188 · March 2, 2026

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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