CompFox AI Summary
This case concerns a dispute over the necessity of applicant's proposed back surgery. The Appeals Board granted reconsideration, finding that the defendant's Utilization Review denial was untimely communicated and thus invalid. However, the Board ultimately rescinded the WCJ's award of surgery because applicant's medical evidence from Dr. Spayde lacked substantial justification and did not demonstrate the surgery's reasonableness or necessity according to established standards. Therefore, the applicant was denied the requested surgical treatment.
Full Decision Text1 Pages
This case concerns a dispute over the necessity of applicant's proposed back surgery. The Appeals Board granted reconsideration, finding that the defendant's Utilization Review denial was untimely communicated and thus invalid. However, the Board ultimately rescinded the WCJ's award of surgery because applicant's medical evidence from Dr. Spayde lacked substantial justification and did not demonstrate the surgery's reasonableness or necessity according to established standards. Therefore, the applicant was denied the requested surgical treatment.
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