CompFox AI Summary
This case concerns a worker's claim for prescribed medications. The employer argued their utilization review denial was timely, precluding the WCJ's jurisdiction over medical necessity. The Appeals Board affirmed the WCJ's finding that the utilization review denial was untimely due to insufficient evidence of proper and timely communication to the physician. Therefore, the WCJ correctly determined the requested Lidoderm, Capsaicin, and Ketamine creams were reasonable and necessary.
Full Decision Text1 Pages
This case concerns a worker's claim for prescribed medications. The employer argued their utilization review denial was timely, precluding the WCJ's jurisdiction over medical necessity. The Appeals Board affirmed the WCJ's finding that the utilization review denial was untimely due to insufficient evidence of proper and timely communication to the physician. Therefore, the WCJ correctly determined the requested Lidoderm, Capsaicin, and Ketamine creams were reasonable and necessary.
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