Lopez, Olga, Applicant v. VILLA TEPEYAC; PREFERRED EMPLOYERS INSURANCE COMPANY, Defendants

WORKERS’ COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
OLGA LOPEZ, Applicant
vs.
VILLA TEPEYAC; PREFERRED EMPLOYERS
INSURANCE COMPANY, Defendants
Adjudication Numbers: ADJ13324854 (MF); ADJ13324858
Los Angeles District Office
OPINION AND ORDER
GRANTING PETITION FOR
RECONSIDERATION AND
DECISION AFTER RECONSIDERATION
Jonathan Kohan Sherman Oaks (lien claimant) seeks reconsideration of the Finding of Fact
and Order (F&O) issued on September 11, 2025 by the workers’ compensation administrative law
judge (WCJ) which found in pertinent part that there was not a qualifying request for authorization
(RFA) for the treatment in question and utilization review (UR) was irrelevant and moot; the issue
of reasonableness and necessity is moot; the validity of the defense bill review is no longer
relevant; Penalties & Interest are moot; and the lien of Dr. Kohan is disallowed. Then WCJ ordered
that the lien of Dr. Kohan is disallowed and that Dr. Kohan take nothing on its lien.
Lien claimant contends that it provided self-procured treatment to applicant while the claim
was denied and its lien should not be reviewed as if the claim was accepted; that it submitted RFAs
electronically and defendant’s explanation of reviews (EORs) should have issued electronically;
and once it established causation and medical necessity, the burden shifted to defendant to rebut
causation and medical necessity, and defendant failed to meet this burden.
We received an Answer from defendant. The WCJ filed a Report and Recommendation
(Report) on the Petition for Reconsideration recommending that the petition be granted for the sole
purpose of determining whether, upon service of the panel qualified medical evaluator (PQME)
report, lien claimant requested retrospective review of the treatment requested prior to March 2021
and whether defendant actually provided that review. Otherwise, the WCJ recommended that

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reconsideration be denied. The WCJ further recommends that both sides be admonished to provide
complete citations to any case they reference in support of their argument.
Lien claimant filed a Reply to Defendant’s Answer to Petition for Reconsideration. Insofar
as lien claimant’s reply constitutes a supplemental pleading, we remind the parties that WCAB
Rule 10964 requires that supplemental pleadings or responses other than the answer shall be
considered only when specifically requested or approved by the Appeals Board. (Cal. Code Regs.,
tit. 8 § 10964(a).) Our Rules further require that a party seeking to file a supplemental pleading shall
file a petition setting forth good cause for the Appeals Board to approve the filing of a supplemental
pleading and shall attach the proposed pleading. (Cal. Code Regs., tit. 8 § 10964(b).) Lien claimant
has not sought the permission of the WCAB to file a supplemental pleading, or set forth good cause
for doing so. Accordingly, we have not considered the September 24, 2025 Reply to Defendant’s
Answer to Petition for Reconsideration herein.
We have considered the allegations of the Petition for Reconsideration, the Answer and the
contents of the Report of the WCJ with respect thereto. Based on our review of the record and for
the reasons discussed below, we will grant lien claimant’s Petition for Reconsideration. We will
not disturb Findings of Fact #1 and #2 to which no party objected, and otherwise rescind the F&O.
We defer all other issues. We return the matter to the WCJ for further proceedings consistent with
this decision.
DISCUSSION
I.
Preliminarily, we note that former Labor Code1 section 5909 provided that a petition for
reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days
from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, Section 5909 was amended to
state in relevant part that:
(a) 	A petition for reconsideration is deemed to have been denied by the appeals
board unless it is acted upon within 60 days from the date a trial judge transmits
a case to the appeals board.
(b)
1 All further references are to the Labor Code unless otherwise noted.

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(1) 	When a trial judge transmits a case to the appeals board, the trial
judge shall provide notice to the parties of the case and the appeals
board.
(2) 	For purposes of paragraph (1), service of the accompanying report,
pursuant to subdivision (b) of Section 5900, shall constitute providing
notice.
Under 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.”
Here, according to Events, the case was transmitted to the Appeals Board on October 1,
2025 and 60 days from the date of transmission is Sunday, November 30, 2025, a weekend. The
next business day that is 60 days from the date of transmission is Monday, December 1, 2025. (See
Cal. Code Regs., tit. 8 § 10600(b).)2 This decision was issued by or on December 1, 2025, so that
we have timely acted on the petition as required by section 5909(a).
Section 5909(b)(1) requires that the parties and the Appeals Board be provided with notice
of transmission of the case. Transmission of the case to the Appeals Board in EAMS provides
notice to the Appeals Board. Thus, the requirement in subdivision (1) ensures that the parties are
notified of the accurate date for the commencement of the 60-day period for the Appeals Board to
act on a petition. Section 5909(b)(2) provides that service of the Report and Recommendation shall
be notice of transmission.
Here, according to the proof of service for the Report and Recommendation by the WCJ,
the Report was served on October 1, 2025, and the case was transmitted to the Appeals Board on
October 1, 2025. Service of the Report and transmission of the case to the Appeals Board occurred
on the same day. Thus, we conclude that the parties were provided with the notice of transmission
required by section 5909(b)(1) because service of the Report in compliance with section
2 WCAB Rule 10600(b) (Cal. Code Regs., tit. 8, § 10600(b)) states that:
Unless otherwise provided by law, if the last day for exercising or performing any right or duty to act or
respond falls on a weekend, or on a holiday for which the offices of the Workers’ Compensation Appeals
Board are closed, the act or response may be performed or exercised upon the next business day.

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5909(b)(2) provided them with actual notice as to the commencement of the 60-day period on
October 1, 2025.
II.
BACKGROUND
In ADJ13324854, from March 1, 1968 through March 17, 2020, applicant alleged
industrial injury to back, shoulders, arm, knee patella, multiple parts more than five major parts,
wrist, neck and abdomen/gastritis.
In ADJ13324858, from March 17, 2019 through March 17, 2020, applicant alleged
industrial injury to psyche and wrist.
On December 15, 2020 a Notice Regarding Denial of Workers’ Compensation Benefits
issued3. (Exhibit A.)
On June 6, 2022 a Notice of Deferral of Medical Treatment Requests issued to lien
claimant. (Exhibit B.) It states in relevant part:
Preferred Employers Insurance Company is unable process your request
for medical treatment authorization because the request is for a claim that
has been denied. As a result, the request for treatment authorization is not
subject to utilization review and is deferred until such time the liability is
determined [§9792.9(b)(1) and §4610(g)(7)(8)].
***
The following pertains specifically to the employee:
Any dispute under this subdivision shall be resolved either by agreement of the
parties or through the dispute resolution process of the Workers’ Compensation
Appeals Board.
(Id. at p. 1.)
On October 27, 2022, the parties filed a fully executed Compromise and Release which
states in relevant part:
WITHOUT ADMITTING LIABILITY, DEFENDANT AGREES TO PAY,
ADJUST, OR LITIGATE ALL LIEN CLAIMS OF RECORD WITH REGARD
TO THE INJURY OF CT: 03/17/2019-03/17/1020, CT: 03/01/1968-03/17/2020
ONLY….WCAB 	JURISDICION 	RESERVED….THE 	C&R 	IS 	BEING
ENTERED INTO WITHOUT A FINAL REPORT AND WITH AOE?COE IN
3 Defendant agrees, Exhibit A denied both claimed dates of injury. (Answer, at pp. 1:28-2:2; 2:5-6.)

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DISPUTE. THE PARTIES WISH TO BUY THEIR RESPECTIVE AND
AVOID THE UNCERTAINTIES AND HAZARDS OF LITGATION.
QME DR. KINNEY AND DR. MORADIAN HAVE ISSUED RESPECTIVE
REPORTS IN THIS CLAIM WHICH ARE NOT FINAL. DEPENDANT HAS
OBJECTED AND MAINTAINS THE POSITION THAT THE REPORTING
DOES 	NOT 	CONSITUTE 	SUBSTANTIAL 	MEDICAL 	EVIDENCE
INLCUDING AS TO FINDINGS OF CAUSATION.
***
THERE IS A DISPUTE REGARDING THE NATURE AND EXTENT OF
INJURY, THE DURATION OF TEMPOARRY DISABILITY, PERMANENT
DISABILITY, EARNINGS, APPORTIONMENT, LIABILITY FOR SELF-
PROCURED MEDICAL TREATMENT, NEED FOR FURTHER MEDICAL
TREATMENT, 	MEDICAL-LEGAL, 	MILEAGE 	EXPENSES, 	OTHER
CLAIMED OUT-OF-POCKET EXPENSES, AND CLAIMED PENALTIES
ON ALL SPECIES OF BENEFITS. TO RESOLVE ALL ISSUES AND
AVOID THE HAZARDS OF DELAYS OF LITIGATION, THE PARTIES
ENTER INTO THIS SETTLEMENT…
(Compromise and Release, at pp. 6-7.)
Addendum B to the Compromise and Release, signed by both parties, further explains the
“serious dispute” regarding industrial causation and described the information defendant planned
to offer in support of its claim of nonindustrial causation should the matter proceed to trial. (Id. at
p. 12.)
In 	Addendum 	C, 	Panel 	QME/AME/PTP 	Final 	Report 	Waiver, 	applicant 	further
acknowledged that she was settling her case without a final medical report. (Id. at p. 14.)
On October 28, 2022 a Joint Order Approving Compromise and Release issued and the
case-in-chief with applicant resolved.
On November 4, 2022, 	Farah Ameri Chiropractic filed a Declaration of Readiness to
Proceed (DOR) to lien conference. No objection to the DOR was filed by any party. From a
continued lien conference on February 22, 2024, the parties jointly requested a continuance to lien
trial.
On July 16, 2025, the matter to proceeded to trial and was submitted on the record. In
ADJ13324854, at issue for trial, injury arising out of and in the course of employment (AOE/COE)
to the neck, wrists, arms, back, shoulders, upper and lower extremities, internal organs and the lien
of Dr. Jonathan Kohan, including penalties and interest, whether there was a qualifying RFA,

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whether the treatment was reasonable and necessary, reasonableness and value of charges, validity
of defense bill review, section 5402(c) and utilization review. (Minutes of Hearing and Order of
Consolidation, at pp. 2-3.)
In ADJ13324858, at issue for trial, injury AOE/COE to wrists, psyche, nervous system and
the lien of Dr. Jonathan Kohan, including penalties and interest, whether there was a qualifying
RFA, whether the treatment was reasonable and necessary, reasonableness and value of charges,
validity of defense bill review, section 5402(c) and utilization review. (Id., at p. 3.)
On September 11, 2025, in ADJ13324854, WCJ found injury AOE/COE to neck, wrists,
arms, back, shoulders, upper and lower extremities and internal organs. (F&O, at p. 1.) In
ADJ13324858, WCJ found injury AOE/COE to wrists, psyche and nervous system. (Id.)
Regarding causation, the WCJ observed:
Based on the reports of Drs. Moradian and Kohan, particularly Exhibits 9 and
19, it is evident that these continuous traumas are industrial in origin. None of
the exhibits reviewed cast any doubt on this conclusion so that these reports
stand as credible and unrebutted.
(Opinion on Decision, at p. 1.)
Regarding the lien at issue, the WCJ found that lien claimant failed to submit any qualifying
RFA for the treatment in question thereby rendering all other lien issues—UR, bill review,
penalties and interest—irrelevant and/or moot. (FOF, at p. 1.) Then WCJ ordered that the lien was
disallowed and lien claimant shall take nothing. (Id. at p. 2.) It is from these findings and order
only that lien claimant seeks reconsideration.
III.
First, we consider the WCJ’s recommendation, absent a denial of the Petition for
Reconsideration, that the petition be granted for the sole purpose of determining whether, upon
service of the PQME report, lien claimant requested retrospective review of the treatment
requested prior to March 2021 and whether defendant actually provided that review. Presumably,
WCJ is referring to the March 27, 2021 PQME report of Maxim Moradian, M.D., wherein the
doctor determined that because of her heavy, repetitive work duties applicant suffered a cumulative

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industrial injury to her thoracic spine, lumbar spine, right shoulder, right and left wrists, left and
right hips, right and left knees and the right ankle.4 (Exhibit 19, at p. 54.)
We disagree with the WCJ’s recommendation.
Specifically, defendant denied the claims on December 15, 2020. (Exhibit A.) On June 6,
2022, defendant issued a Notice of Deferral of Medical Treatment Requests, indicating that this
claim was denied. (Exhibit B, at p. 1.) Accordingly, any request for treatment authorization was
not subject to utilization review and was deferred until such time the liability is determined. (Cal.
Code Regs., tit. 8 § 9792.9(b)(1).)
Thereafter, before any final report was obtained from Dr. Moradian, the case-in-chief
settled informally between the parties. Repeatedly in their Compromise and Release settlement
agreement, the parties memorialized that liability for the industrial event was in still dispute.
Hence, liability was not determined in these matters until September 11, 2025 when the WCJ
issued his unchallenged Findings of Fact #1 and #2 regarding causation of industrial injury.
Now that occupational injury has been determined, we proceed to section 4610(l)(m)
effective January 1, 2018 on this issue which states in relevant part:
(l) 	Utilization review of a treatment recommendation shall not be required
while the employer is disputing liability for injury or treatment of the condition
for which treatment is recommended pursuant to Section 4062.
(m) 	If utilization review is deferred pursuant to subdivision (l), and it is finally
determined that the employer is liable for treatment of the condition for which
treatment is recommended, the time for the employer to conduct retrospective
utilization review in accordance with paragraph (2) of subdivision (i) shall begin
on the date the determination of the employer’s liability becomes final, and the
time for the employer to conduct prospective utilization review shall commence
from the date of the employer’s receipt of a treatment recommendation after the
determination of the employer’s liability.
(Lab. Code, § 4610(l)(m).)
Additionally, as indicated by defendant in its Exhibit B denial notice, WCAB Rule
9792.9(b)(2) states:
If utilization review is deferred pursuant to this subdivision, and it is finally
determined that the claims administrator is liable for treatment of the condition
4 We note that the March 27, 2021 PQME report of Dr. Moradian, was not a final report as applicant was not MMI
because on date of examination she was temporary partially disabled, necessary treatment was outstanding, some
records for review were outstanding and a reevaluation would be necessary after the treatment was completed or in
about six months’ time. (Exhibit 19 at pp. 53-55.)

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for which treatment is recommended, either by decision of the Workers’
Compensation Appeals Board or by agreement between the parties, the time for
the 	claims 	administrator 	to 	conduct 	retrospective 	utilization 	review 	in
accordance with this section shall begin on the date the determination of the
claims 	administrator’s 	liability 	becomes 	final. 	The 	time 	for 	the 	claims
administrator to conduct prospective utilization review shall commence from the
date of the claims administrator’s receipt of a DWC Form RFA after the final
determination of liability.
(Cal. Code Regs., tit. 8 § 9792.9(b)(2).)
Lastly, we admonish the parties for lack of proper citation to legal authority as stated by
the WCJ in the Report at p. 7.
Accordingly, we will grant reconsideration, rescind the September 11, 2025 Findings of
Fact and Order, and substitute them with new Findings of Fact, as provided below, restating the
unchallenged WCJ’s Findings of Fact #1 and #2, which determined liability for these claims. Upon
return to the trial level, all other issues regarding the lien can be adjudicated.
Based on the foregoing,

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IT IS ORDERED that the Petition for Reconsideration is GRANTED.
IT IS FURTHER ORDERED as the Decision After Reconsideration of the Workers’
Compensation Appeals Board that the Finding of Fact and Order issued on September 11, 2025,
is RESCINDED, and that new Findings of Fact, as provided below, be SUBSTITUTED in its
place.
FINDINGS OF FACT
1. 	In case number ADJ13324854, Applicant, OLGA LOPEZ, aged 63 on the
date of injury, while employed as a waitress at South El Monte, California by
VILLA TEPEYAC, sustained injury arising out of and in the course of said
employment during the period of March 1968 to 17 March 2020 to her neck, wrists,
arms, back, shoulders, upper & lower extremities and internal organs.
2. 	In case number ADJ13324858, Applicant, OLGA LOPEZ, aged 63 on the
date of injury, while employed as a waitress at South El Monte, California by
VILLA TEPEYAC, sustained injury arising out of and in the course of said
employment on during the period of 17 March 2019 to 17 March 2020 to her wrists,
psyche and nervous system. The 5402(c) presumption need not apply.

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3. 	All other issues are deferred.
WORKERS’ COMPENSATION APPEALS BOARD
/s/ JOSEPH V. CAPURRO, COMMISSIONER
I CONCUR,
/s/ KATHERINE A. ZALEWSKI, CHAIR
/s/ PAUL F. KELLY, COMMISSIONER
DATED AND FILED AT SAN FRANCISCO, CALIFORNIA
December 1, 2025
SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED BELOW AT
THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD.
JONATHAN F. KOHAN, M.D.
SYNAPSE LIEN UNIT
MEDICAL COST REVIEW
SL/abs
I certify that I affixed the official seal of the
Workers’ Compensation Appeals Board to this
original decision on this date. 	abs