Home/Case Law/JOSE MARTINEZ vs. JACK NEAL & SON, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, CAMBRIDGE INTEGRATED SERVICES
Regular DecisionReconsideration

JOSE MARTINEZ vs. JACK NEAL & SON, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, CAMBRIDGE INTEGRATED SERVICES

Filed: Oct 18, 2010
San Francisco
ADJ4360135

CompFox AI Summary

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the administrative law judge's award of medical treatment. CIGA argued the treatment was improperly authorized due to the applicant's alleged failure to object to prior utilization review (UR) denials. However, the Board found CIGA waived this defense by not raising it at trial, and instead litigated the merits of the treatment request. The evidence supported the treating physician's recommendations for a motorized wheelchair, new walker, assisted transportation, exercise, and massage as reasonable and necessary for the applicant's industrial back injury.

Full Decision Text1 Pages

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the administrative law judge's award of medical treatment. CIGA argued the treatment was improperly authorized due to the applicant's alleged failure to object to prior utilization review (UR) denials. However, the Board found CIGA waived this defense by not raising it at trial, and instead litigated the merits of the treatment request. The evidence supported the treating physician's recommendations for a motorized wheelchair, new walker, assisted transportation, exercise, and massage as reasonable and necessary for the applicant's industrial back injury.

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