Thomas McMillan, Leeann, Applicant v. LOS ANGELES COUNTY DISTRICT ATTORNEY, permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants

WORKERS’ COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
LEEANN P. THOMAS MCMILLAN, Applicant
vs.
LOS ANGELES COUNTY DISTRICT ATTORNEY, permissibly self-insured,
administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Defendants
Adjudication Numbers: ADJ4187849; ADJ353229
Los Angeles District Office
OPINION AND ORDER
DENYING PETITION FOR
RECONSIDERATION
Defendant seeks reconsideration of the August 13, 2025 Joint Findings of Fact and Order
(F&O), wherein the workers’ compensation administrative law judge (WCJ) found that in Case
No. ADJ353229, applicant, while employed from November 6, 2002 to November 6, 2003,
sustained industrial injury to her psyche, bilateral wrists, bilateral elbows, bilateral shoulders,
dental, upper gastrointestinal tract, rheumatology, and hypertension. 	In ADJ4187849, the WCJ
found that applicant, while employed from June 26, 2005 to June 26, 2006, sustained industrial
injury to her psyche, 	bilateral wrists, bilateral elbows, bilateral shoulders, dental, upper
gastrointestinal tract, rheumatology, and hypertension. In both cases, the WCJ determined that the
parties were bound by their prior stipulations to submit home health care issues to the Agreed
Medical Evaluator (AME), and that applicant’s engagement with the Independent Medical Review
(IMR) process did not waive that stipulation.
Defendant contends that an April 18, 2024 Order denying defendant’s Petition for Change
of Venue also provides that home health care issues are to be determined by the Utilization Review
(UR) and IMR processes and supersedes the parties’ stipulation. Defendant further contends
applicant has breached the home health care stipulation by failing to timely appoint a primary
treating physician, and that applicant waived the argument that the dispute is controlled by the
parties’ prior stipulations when she submitted the matter to IMR.

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We 	have 	received 	an 	Answer 	from 	applicant. 	The 	WCJ 	prepared 	a 	Report 	and
Recommendation on Petition for Reconsideration (Report), recommending that the Petition be
denied.
We have considered the Petition for Reconsideration, the Answer, and the contents of the
Report, and we have reviewed the record in this matter. For the reasons discussed below, we
will deny reconsideration.
FACTS
The relevant facts are set forth in the WCJ’s Report, as follows:
The central issue for the current litigation is home health care. The underlying
case was the subject of a Stipulation with Award for 99% disability on June 12,
2014. The Stipulation with Request for Award stated in the Addendum 3 at Item
11 “Defendant’s agree to have AME, Dr. Michael Luciano address the homecare
needs of the applicant both on a current and retroactive basis”. Exhibit 10. A
further Stipulation with Request for Award was approved by WCJ Tolman on
3-16-2021 which adds terms but continues the AME as the final determiner of
the home health care needs of the applicant. Exhibit 6.
On 4-18-2024 the parties appeared before PWCJ Rassp on a Petition to Change
Venue. The Order by WCJ Rassp denies the change of venue. Exhibit E. The
PWCJ did not hear testimony, did not go on the record, and did not make a
finding on home health care.
The parties have not returned to AME Luciano to evaluate the applicant for
home health care needs, although the doctor is still practicing medicine and is
otherwise available. Defendants scheduled an appointment which was cancelled
on 6-12-2024, Exhibit 4.
Defendant employed the UR process regarding an 8-7-2024 report of treating
doctor Rubanenko, which led to a denial of home health care on 10-7-2024.
Exhibit 3, Exhibit B. An IMR Decision issued 12-11-2024 upholding the
decision. Exhibit D. Home Health Care was terminated by defendants on 9-30-
2024.
Defendants had furnished home health care 4 hours per day, 7 days a week from
9-1-2013 to 9-30-2024. MOH/SOE 5-28-2025 Stipulated Facts, p.2.
(Report, at p. 3.)
The F&O determined in relevant part that the parties’ stipulation to utilize an AME
Dr. Luciano for resolving home health care issues, as described in the March 16, 2021 Stipulations

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and Order continues in full force and effect. (Findings of Fact No. 4 & 15.) The WCJ further
determined that applicant did not “consent to the IMR process by not objecting to the UR process.”
(Findings of Fact Nos. 5 & 16.) Finally, the WCJ determined that the April 18, 2024 Order denying
defendant’s Petition for Change of Venue did not supersede the parties’ stipulation regarding home
health care. (Findings of Fact Nos. 6 & 17.)
Defendant’s Petition contends the April 18, 2024 Order Denying Change of Venue
included an order that “defendant was not entitled to have the case transferred to Oxnard to be
heard by the judge that originally issued the [March 16, 2021] decision because ‘Home Health
Care issues are determined by the UR and IMR processes.’” (Petition, at p. 3:4.) Defendant further
contends that applicant is in material breach of the agreement regarding home health care because
she failed to timely appoint a primary treating physician between at least October 28, 2015 and
July, 2024. (Id. at p. 4:5.) Defendant also contends that applicant waived her right to object to the
UR/IMR process by invoking the IMR process without reservation and failing to object to that
process until after an adverse determination issues. (Id. at p. 4:22.)
Applicant’s Answer responds that the Petition was not served on all parties as required
under Labor Code1 section 5905. (Answer, at p. 4:11.) Applicant also observes that while an
employer’s decision to deny or modify a physician’s request for specific medical services for an
injured employee is generally subject to the UR/IMR process, two recognized exceptions to the
UR/IMR process arise when either the UR decision is untimely, or when the parties have agreed
to waive their right to the statutory review process. (Id. at p. 7:13.)
The WCJ’s Report observes that the parties have entered into two separate agreements to
have the home health care issues resolved by AME Dr. Luciano. The WCJ observes that “the
parties are bound by what they agreed to, and what the Judge ordered.” (Report, at p. 6.) With
respect to whether the intervening denial of defendant’s Petition for Change of Venue superseded
the parties’ stipulation to submit home health care disputes to the AME, the WCJ observes:
The Orders of WCJ Tolman are Awards based on Stipulations of the parties,
which include a provision for resolving home health care disputes solely by the
AME. The Order of PWCJ Rassp denies a change of venue to Oxnard. The Order
by the PWCJ does not modify the Awards. There is no conflict.
(Id. at p. 8.)
1 All further references are to the Labor Code unless otherwise noted.

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Accordingly, the WCJ recommends we deny defendant’s Petition. (Id. at p. 9.)
DISCUSSION
I.
Former 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) 	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
September 22, 2025, and 60 days from the date of transmission is November 21, 2025. This
decision is issued by or on November 21, 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.

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Here, according to the proof of service for the Report and Recommendation by the workers’
compensation administrative law judge, the Report was served on September 22, 2025, and the
case was transmitted to the Appeals Board on September 22, 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 5909(b)(2) provided them with actual notice as
to the commencement of the 60-day period on September 22, 2025.
II.
California’s workers’ compensation system makes the employer of an industrially injured
employee responsible for all medical treatment reasonably necessary to cure or relieve the injured
employee from the effects of his or her injury. (Lab. Code, § 4600.) Employers are required to
conduct UR of treatment requests received from physicians. (Lab. Code, § 4610; State Comp. Ins.
Fund v. Workers’ Comp. Appeals Bd. (2008) 44 Cal.4th 230, 236 [73 Cal.Comp.Cases 981]
(Sandhagen).) The purpose of California’s UR requirement, “... is to ensure quality, standardized
medical care for workers in a prompt and expeditious manner,” since UR “balances the dual
interests of speed and accuracy, emphasizing the quick resolution of treatment requests, while
allowing employers to seek more time if more information is needed to make a decision.”
(Sandhagen, supra, 44 Cal.4th at 241.)
Upon receipt of a request for authorization (RFA) for medical treatment, the employer has
two options: they may either approve the treatment request or submit the matter to UR. To
determine the medical necessity of the treatment recommendations by treating physicians, the
employer must follow the UR process codified in section 4610(a). (Lab. Code, § 4610(a).) Through
this UR process, when an employee’s treating physician submits an RFA to an employer and the
employer does not approve the treatment, a corresponding UR physician will then evaluate
whether the requested treatment is “medically necessary,” and on that basis will either: (1)
approve; (2) modify; or (3) deny the requested treatment. (Lab. Code, § 4610(a), (c), (e) & (g)(4).)
If the UR decision modifies or denies the requested treatment, the injured employee can challenge
that UR decision through the Independent Medical Review (“IMR”) process where an IMR
physician evaluates the medical necessity of the disputed treatment. (Lab. Code, §§ 4610.5(c)(2)
& (3), (k), 4610.6(a), (c) & (e).)

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In Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298, 1299 (Appeals
Board en banc) (Dubon II), we held that if a UR decision is untimely, the UR decision is invalid
and not subject to IMR. The Dubon II decision further held that the Appeals Board has jurisdiction
to decide the underlying factual issue of whether a UR decision is timely. (Id.) If a UR decision is
untimely, and therefore invalid, the determination of medical necessity for the treatment requested
may be made by the Appeals Board. (Id. at p. 1300.) If a UR decision is timely, and therefore valid,
IMR is the sole remedy for an injured employee to challenge a UR decision that modifies or denies
the treatment.
In Allied Signal Aero. v. Workers’ Comp. Appeals Bd. (Wiggs) (2016) 35 Cal.App.5th
1077, 1081 [84 Cal.Comp.Cases 367], the Court of Appeal confirmed that the two exceptions
where the Appeals Board has jurisdiction to consider the issue of whether the requested medical
treatment is medically necessary are when the UR decision is untimely or when the parties have
agreed to waive their right to pursue the statutory review process of UR/IMR.
In Wiggs, supra, 35 Cal.App.5th 1077, the parties entered into a stipulation regarding
housekeeping services in which an agreed nurse case manager (NCM) would perform a home
assessment for housekeeping services and prepare and submit a report to applicant’s treating
physicians for review and comment. (Id. at p. 1082.) Again, the Court recognized the Appeals
Board’s jurisdiction to consider the factual issue of whether the parties had entered into a valid
stipulation, but determined that the agreement was essentially for a one-time evaluation rather than
an ongoing agreement to submit all present and future housekeeping disputes to the NCM, and that
nothing in the language of the agreement purported to supplant the UR/IMR review process by
providing that the NCM would actually decide any disputes. Accordingly, “[s]ince there was no
stipulation to displace the provision of home health care from the UR-IMR process, the appeals
board had no jurisdiction to review the medical necessity and reasonableness of home health care.”
(Id. at p. 1087.)
Here, however, the parties have on two occasions entered into stipulations specifically
designed to displace the provision of home health care from the UR-IMR process. In a stipulation
approved by a WCJ on October 28, 2015, the parties agreed in relevant part to the following:
Furthermore, treating doctor is to provide request for home healthcare at
intervals of no longer than 6 months and at the request of the parties, AME, Dr.
Michael Luciano is to review said request at intervals of no longer than once per
year. If treating doctor changes homecare recommendation applicant will be re-

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evaluated by Dr. Luciano for final determination. All penalties and interest
waived if payment is commenced within 30 days from the service of the itemized
statements.
(Stipulation and Award and/or Order, dated October 28, 2018.)
On November 15, 2018, the parties entered into an interim stipulation whereby defendant
agreed to reimburse applicant’s provider for certain home health care expenses, and the parties
agreed that “all home care bills have now been paid to date.” (Stipulation and Award and/or Order,
dated November 15, 2018.)
On March 16, 2021, the parties entered into another stipulation, providing in relevant part:
The primary treating physician is to provide request for HHC [home health care]
for at (sic) intervals no longer than 6 months and at the request of the parties,
AME Dr. Luciano is to review said request at intervals of no longer than once
per year. If the treating doctor changes the HHC recommendations, then
applicant will be re-evaluated by Dr. Luciano for final determination.
(Addendum to Stipulation and Award and/or Order, dated March 16, 2021, at p. 1:27.)
Thus, the parties have agreed that disputes regarding the ongoing provision of home health
care are to be submitted to AME Dr. Luciano “for final determination.” (Addendum to Stipulation
and Award and/or Order, dated March 16, 2021, at p. 2:2.)
We note that in Wiggs, the Court first considered the underlying factual issue of whether
there was a valid stipulation and determined that there was no valid stipulation. Here, and
consistent with the analysis in Wiggs, in order to determine whether the parties were required to
proceed with UR/IMR the WCJ first considered the underlying factual issue of whether the parties
entered into a valid stipulation to “displace the provision of home health care from the UR-IMR
process.” Based on a different set of facts than those in Wiggs, the WCJ in the present matter
determined that the parties’ stipulation was valid, so that jurisdiction had been reserved to the
Appeals Board to determine the issue of medical necessity. (Wiggs, supra, 35 Cal.App.5th at
p. 1087; see also Chavez v. Supreme Truck Bodies (September 21, 2018, ADJ155904 (LAO
0811479) [2018 Cal. Wrk. Comp. P.D. LEXIS 449]; Payne v. Federal Express (May 31, 2017,
ADJ2117331 (OAK 0261803) [2017 Cal. Wrk. Comp. P.D. LEXIS 243]; Schendel v. B & B Sales
(November 15, 2016, ADJ3568698 (MON 0246436) [2016 Cal. Wrk. Comp. P.D. LEXIS 623];
Bertrand v. City of Orange, supra, 2014 Cal. Work. Comp. P.D. LEXIS 342].)

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Defendant does not dispute that such an agreement is legally proper but contends that
applicant waived this agreement by her conduct in voluntarily submitting the August 7, 2024
adverse UR determination to IMR. (Petition, at p. 4:26.) However, defendant cites to no authority
for the proposition that applicant may not seek to enforce a prior stipulation regarding home health
care while, in the alternative, engaging in the statutorily prescribed IMR process under section
4610.5. Rather, applicant had the right (and her attorney the obligation) to pursue all available
remedies while the underlying dispute regarding home health care was pending. (See, e.g., Federal
Express Corp. v. Workers’ Comp. Appeals Bd. (Payne) (2017) 82 Cal.Comp.Cases 1014 [2017
Cal. Wrk. Comp. LEXIS 91]; see also Bertrand, supra, 2014 Cal. Wrk. Comp. P.D. LEXIS 342.)
Defendant further asserts that the April 18, 2024 order issued by a Presiding Workers’
Compensation Administrative Law Judge (PWCJ) denying defendant’s petition for change of
venue also determined that “home healthcare issues are determined by the UR and IMR processes.”
(Petition, at p. 3:4.) Defendant asserts that this statement effectively supersedes the parties’
stipulations with respect to home health care, and that the order of the PWCJ is in direct conflict
with the instant Findings of Fact. (Petition, at p. 3:4.)
However, additional context is necessary to understand the scope of the April 18, 2024
order. On March 15, 2024, defendant petitioned to change venue from Los Angeles to the Oxnard
district office, ostensibly so that the issue of home health care could be heard in front of the same
WCJ who issued the March 16, 2021 Stipulation and Order. The relief sought in the petition does
not include setting aside the parties’ prior stipulations, only averring defense counsel’s belief that
a transfer of venue “would facilitate resolution” of “applicant’s on going (sic) request for ‘home
healthcare services.’” (Petition for Change of Venue, dated March 15, 2024, at p. 1:22.) In
response, the PWCJ issued an order which states, in relevant part, that “[d]efendant’s petition for
change of venue does not state any good cause, specific names and addresses of potential defense
witnesses, or offers of proof under LC 5501.6. Home health care issues are determined by UR and
IMR processes. Defendant’s Petition is denied.” (Order Denying Defendant’s Petition [for]
Change of Venue; Order Denying Applicant’s Petition for Automatic Reassignment of Trial Judge,
dated April 18, 2024.) The WCJ’s Report observes:
The PWCJ ruled on the change of venue petition in the first line of the Order
Denying Change of Venue. He then went on to list a variety of further support
for his decision. None are framed as findings. The PWCJ notes at the very end
of the one paragraph Order “Home health care issues are determined by UR and

9
IMR processes.” This is a general statement, not a finding in this case or an
Order to the parties to act accordingly. The PWCJ does not void the prior
Awards.
(Report, at p. 8.)
We concur with the WCJ’s analysis of the import of the PWCJ’s April 18, 2024 order. The
order itself offers multiple reasons for why defendant’s change of venue petition did not establish
good cause to change venue, including why the petition failed from a procedural standpoint, as
well as a general statement that home health care issues are generally decided through the UR-
IMR process. We decline to read into the April 18, 2024 order denying change of venue a
substantive decision on the issue of whether the parties’ prior stipulations to submit home health
care disputes to an AME remained in effect. (See 9 Witkin, Cal. Procedure (4th ed. 1997) Appeal,
§ 947, pp. 989–991 [“It is axiomatic that cases are not authority for propositions they did not
consider or address.”]; Gomez v. Superior Court (2005) 35 Cal. 4th 1125, 1153.) We therefore
agree with the WCJ’s conclusion that the “Order Denying Change of Venue of 4-18-2024 by
Presiding Judge Rassp, Exhibit E, did not determine jurisdiction of the home health care issue.”
(Findings of Fact Nos. 6 & 17.)
Finally, and insofar as defendant contends that applicant “voided” the parties’ stipulation
by failing to timely nominate a new treating physician, we agree with the WCJ’s assertion that
because the parties’ stipulations to submit home health care disputes was approved and ordered
by the WCJ, the parties are obligated to comply with that order. In the face of substantive
noncompliance with a court order, the Appeals Board retains jurisdiction over its prior orders, and
either party may institute proceedings to request enforcement of a prior order. (Lab. Code, § 5803;
see Barnes v. Workers’ Comp. Appeals Bd. (2000) 23 Cal.4th 679 [65 Cal.Comp.Cases 780].)
Accordingly, we deny the Petition for Reconsideration.

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For the foregoing reasons,
IT IS ORDERED that the Petition for Reconsideration is DENIED.
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
November 21, 2025
SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED BELOW AT
THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD.
LEEANN THOMAS MCMILLAN
GLAUBER BERENSON VEGO
ROBINSON DILANDO
SAR/abs
I certify that I affixed the official seal of the
Workers’ Compensation Appeals Board to this
original decision on this date. 	abs