CompFox AI Summary
This case involves a dispute over the authorization of an orthopedic mattress for a workers' compensation applicant. The defendant denied the request through utilization review, citing lack of supporting medical guidelines. The Appeals Board reversed the WCJ's award, finding the applicant failed to properly initiate the dispute resolution process under Labor Code section 4062(a). The matter was returned to the trial level for referral to the Agreed Medical Examiner to address the medical necessity of the mattress.
Full Decision Text1 Pages
This case involves a dispute over the authorization of an orthopedic mattress for a workers' compensation applicant. The defendant denied the request through utilization review, citing lack of supporting medical guidelines. The Appeals Board reversed the WCJ's award, finding the applicant failed to properly initiate the dispute resolution process under Labor Code section 4062(a). The matter was returned to the trial level for referral to the Agreed Medical Examiner to address the medical necessity of the mattress.
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