CompFox AI Summary
This case concerns a dispute over the necessity of prescription pain medications for Tommy Gutierrez. The defendant, Bigge Crane & Rigging Company, sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded the medications. The core issue was the defendant's failure to prove timely communication of their utilization review (UR) decision to the applicant's treating physician, Dr. Abeles, within 24 hours. As a result, the UR decision was deemed untimely and invalid, allowing the WCAB to determine medical necessity. The Board affirmed the original award, finding substantial medical evidence supported the applicant's continued need for the medications to manage chronic pain.
Full Decision Text1 Pages
This case concerns a dispute over the necessity of prescription pain medications for Tommy Gutierrez. The defendant, Bigge Crane & Rigging Company, sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded the medications. The core issue was the defendant's failure to prove timely communication of their utilization review (UR) decision to the applicant's treating physician, Dr. Abeles, within 24 hours. As a result, the UR decision was deemed untimely and invalid, allowing the WCAB to determine medical necessity. The Board affirmed the original award, finding substantial medical evidence supported the applicant's continued need for the medications to manage chronic pain.
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