CompFox AI Summary
This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.
Full Decision Text1 Pages
This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.
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