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Case No. ADJ3796500

Regular

Oct 13, 2010

JEFFREY DIXON vs. FALCON TRADING CO., INC., STATE COMPENSATION INSURANCE FUND

The defendant, SCIF, sought reconsideration of an order requiring them to authorize specific medical treatment for the applicant, which had been denied by utilization review. SCIF argued the applicant failed to follow statutory procedures for dispute resolution regarding medical treatment. However, the Appeals Board denied reconsideration because SCIF waived this procedural defense by not raising it at trial. The sole issue litigated was the reasonableness of the medical treatment, for which the applicant presented substantial evidence. Therefore, the prior order mandating authorization of the treatment was upheld.

Utilization ReviewAgreed Medical ExaminerQualified Medical ExaminerLabor Code Section 4062Labor Code Section 4062.2Declaration of Readiness to ProceedWorkers' Compensation Appeals BoardIndustrial InjuryMedical TreatmentOxycontin

References

Case No. ADJ2086501 (SFO 0318776)

Regular

Nov 07, 2014

KIM McCOOL (NELSON) vs. MONTEREY BAY MEDICAR, ARROWOOD INDEMNITY COMPANY

This case involves a dispute over the authorization of pain medications for an applicant with a 1983 back injury. The employer initially denied medications based on utilization review but later approved them. The administrative law judge still awarded the medications, but the Appeals Board granted reconsideration. The Board rescinded the award, finding no actual dispute existed at the hearing and that the prior denial, though flawed, did not warrant the judge's ruling. The Board also noted concerns about the utilization review process potentially violating regulations.

Utilization ReviewPetition for ReconsiderationFindings and AwardOxyContinNorcoLyricaAmbulance DriverPermanent DisabilityExpedited HearingMedical Treatment

References

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JEFFREY DIXON vs. FALCON TRADING CO., INC., STATE COMPENSATION INSURANCE FUND

KIM McCOOL (NELSON) vs. MONTEREY BAY MEDICAR, ARROWOOD INDEMNITY COMPANY

Utilization ReviewPetition for ReconsiderationFindings and AwardOxyContinNorcoLyricaAmbulance DriverPermanent DisabilityExpedited HearingMedical Treatment