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

Case No. ADJ8765068, ADJ8765078, ADJ8841406

Regular

Nov 18, 2015

WILLIAM MCBURNEY vs. ALL THAT GLITTERS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) is granting reconsideration on its own motion to correct a clerical error in a prior decision. The error incorrectly identified the physician authorized for surgery; the original decision will be affirmed with this correction. Specifically, Order A is amended to authorize Michael Laird, M.D. for a left total knee arthroplasty, not Dr. James Strait.

Workers' Compensation Appeals BoardReconsiderationClerical ErrorAgreed Medical EvaluatorPrimary Treating PhysicianLeft Total Knee ArthroplastyJoint Findings and OrderFindings of Fact Award and OrdersOpinion and Decision After ReconsiderationSan Luis Obispo

References

Case No. ADJ8858239, ADJ8858240

Regular

Oct 13, 2016

ANTOINETTE MIRANDA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured

This case concerns the timeliness of an Independent Medical Review (IMR) determination for a left knee total arthroplasty. The WCJ found the IMR determination was late and the WCAB had jurisdiction, but denied the surgery due to insufficient evidence of medical necessity. The Appeals Board granted reconsideration, affirming the denial of treatment but clarifying that the timeframe for IMR issuance under Labor Code section 4610.6(d) is directory, not mandatory. Therefore, the late IMR determination is valid, and the applicant is bound by its decision regarding the medical necessity of the proposed surgery.

Independent Medical ReviewUtilization ReviewLabor Code Section 4610.6(d)Directory vs. Mandatory TimeframeMedical NecessityLeft Knee Total ArthroplastyWCJWCABPetition for ReconsiderationReport and Recommendation

References

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WILLIAM MCBURNEY vs. ALL THAT GLITTERS, EMPLOYERS COMPENSATION INSURANCE COMPANY

ANTOINETTE MIRANDA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured