Case Law Database

MATT JACOBS vs. PARSEC, INC./BUDCO; ACE USA

This case denied an applicant's petition for reconsideration of a decision upholding an Independent Medical Review (IMR) denial of knee surgery authorization. The applicant argued the IMR determination was invalid due to untimeliness, but the Board found the statutory timeframes for IMR decisions are directory, not mandatory. Therefore, a delay in the IMR decision does not invalidate it, and the applicant remains bound by the IMR's finding on the medical necessity of the proposed treatment. The Board affirmed the WCJ's decision, denying the applicant's petition for reconsideration.