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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ369598 (OAK 0301691)

Regular

Jan 23, 2015

ALLEN AMES vs. COINMACH LAUNDRY, ARROWHEAD INDEMNITY COMPANY

The Appeals Board granted reconsideration to review the WCJ's award of medical treatment based on untimely utilization review (UR) and a previous case. The Board rescinded the WCJ's decision due to a dispute over the timeliness of the UR denial, returning the matter for further development of the record on that specific issue. However, the Board did award a left-sided rhizotomy based on the parties' stipulation, as the applicant had not yet obtained the authorized treatment. The issue of a spinal cord stimulator was deferred as the authorization request was made post-hearing.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderUtilization ReviewTimelinessRequests for AuthorizationMedical TreatmentSpinal Cord StimulatorRhizotomyLabor Code

References

Case No. ADJ3700908 (SRO 0101979) ADJ3874442 (SRO 0098853)

Regular

Jul 18, 2014

Randall Otten vs. Cardinal Newman High School, California Insurance Guarantee Association for Superior National Insurance Company, in liquidation

This case concerns the validity of a Utilization Review (UR) determination regarding the applicant's need for a radiofrequency rhizotomy injection for his low back injury. The Appeals Board reversed the lower judge's decision, finding the UR determination valid. They held that the omission of certain medical reports was not a material procedural defect because they would not have changed the UR physician's conclusion. Furthermore, the Board found the applicant failed to present substantial medical evidence to support the necessity of the treatment or prove the UR was invalid. The issue of medical necessity is now subject to Independent Medical Review (IMR).

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardMaterial Procedural DefectDubonEvidence-Based GuidelinesAgreed Medical EvaluatorTreating Physician

References

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ALLEN AMES vs. COINMACH LAUNDRY, ARROWHEAD INDEMNITY COMPANY

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderUtilization ReviewTimelinessRequests for AuthorizationMedical TreatmentSpinal Cord StimulatorRhizotomyLabor Code

Randall Otten vs. Cardinal Newman High School, California Insurance Guarantee Association for Superior National Insurance Company, in liquidation