CompFox AI Summary
In this workers' compensation case, the Appeals Board reversed a prior decision denying an employer's appeal of an Independent Medical Review (IMR) determination. The Board found the IMR determination for a knee cartilage transplant was plainly erroneous and acted in excess of the Administrative Director's powers. This was due to a direct contradiction between the IMR's finding of medical necessity and its stated rationale. Consequently, the Board granted the employer's appeal and remanded the case for a new IMR review by a different reviewer.
Full Decision Text1 Pages
In this workers' compensation case, the Appeals Board reversed a prior decision denying an employer's appeal of an Independent Medical Review (IMR) determination. The Board found the IMR determination for a knee cartilage transplant was plainly erroneous and acted in excess of the Administrative Director's powers. This was due to a direct contradiction between the IMR's finding of medical necessity and its stated rationale. Consequently, the Board granted the employer's appeal and remanded the case for a new IMR review by a different reviewer.
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