Home/Case Law/Kelly Tinsley vs. VERTIS COMMUNICATIONS, ACE USA INSURANCE
Regular DecisionWorkers' Compensation

Kelly Tinsley vs. VERTIS COMMUNICATIONS, ACE USA INSURANCE

Filed: Sep 14, 2015
Anaheim
ADJ7286862, ADJ7604060

CompFox AI Summary

This case involves a denial of a defendant's petition for reconsideration regarding a workers' compensation award. The defendant's Utilization Review (UR) of the applicant's requested continued treatment at a residential rehabilitation center was deemed invalid by the Administrative Law Judge (ALJ) due to untimeliness in communication. The Workers' Compensation Appeals Board (WCAB) affirmed the ALJ's decision, finding the UR invalid because the defendant failed to prove timely communication to the physician as required by statute. Consequently, the WCAB upheld the award of continued treatment, deeming it reasonable and supported by substantial medical evidence.

Full Decision Text1 Pages

This case involves a denial of a defendant's petition for reconsideration regarding a workers' compensation award. The defendant's Utilization Review (UR) of the applicant's requested continued treatment at a residential rehabilitation center was deemed invalid by the Administrative Law Judge (ALJ) due to untimeliness in communication. The Workers' Compensation Appeals Board (WCAB) affirmed the ALJ's decision, finding the UR invalid because the defendant failed to prove timely communication to the physician as required by statute. Consequently, the WCAB upheld the award of continued treatment, deeming it reasonable and supported by substantial medical evidence.

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Kelly Tinsley vs. VERTIS COMMUNICATIONS, ACE USA INSURANCE (2015) – Anaheim | CompFox