CompFox AI Summary
The Workers' Compensation Appeals Board granted reconsideration and rescinded an earlier award ordering the defendant to authorize a nurse case manager. The Board found that the applicant's treating physician's recommendation for a nurse case manager, citing "complexity" and "miscommunication," lacked the specific medical reasoning required to establish necessity. The current ruling emphasizes that the applicant bears the burden of proving medical necessity through detailed evidence.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board granted reconsideration and rescinded an earlier award ordering the defendant to authorize a nurse case manager. The Board found that the applicant's treating physician's recommendation for a nurse case manager, citing "complexity" and "miscommunication," lacked the specific medical reasoning required to establish necessity. The current ruling emphasizes that the applicant bears the burden of proving medical necessity through detailed evidence.
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