CompFox AI Summary
This case concerns the denial of ongoing aqua therapy for applicant Thomas Cullen, who suffered a 1998 work injury resulting in 100% permanent disability and future medical care. The defendant employer and insurer argued their Utilization Review (UR) denial was timely and binding, and that the WCJ misapplied precedent. The Appeals Board affirmed the WCJ's decision to award the aqua therapy, finding the defendant's UR decision invalid due to procedural issues. As a result, the WCJ could properly determine the treatment was reasonable and medically supported by substantial evidence, especially since the applicant's condition worsened when therapy was withdrawn.
Full Decision Text1 Pages
This case concerns the denial of ongoing aqua therapy for applicant Thomas Cullen, who suffered a 1998 work injury resulting in 100% permanent disability and future medical care. The defendant employer and insurer argued their Utilization Review (UR) denial was timely and binding, and that the WCJ misapplied precedent. The Appeals Board affirmed the WCJ's decision to award the aqua therapy, finding the defendant's UR decision invalid due to procedural issues. As a result, the WCJ could properly determine the treatment was reasonable and medically supported by substantial evidence, especially since the applicant's condition worsened when therapy was withdrawn.
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