CompFox AI Summary
This case concerns a defendant's petition for reconsideration of an order authorizing left shoulder surgery. The defendant argued a prior utilization review denial should prevent subsequent authorizations, citing Labor Code section 4610(k). However, the applicant's physician resubmitted the request with additional supporting documentation, triggering a new utilization review. This subsequent review certified the surgery as medically necessary, resolving the medical dispute. The Board denied reconsideration, holding that the defendant voluntarily submitted the resubmitted request, making the February 2, 2022 certification final and precluding further utilization review.
Full Decision Text1 Pages
This case concerns a defendant's petition for reconsideration of an order authorizing left shoulder surgery. The defendant argued a prior utilization review denial should prevent subsequent authorizations, citing Labor Code section 4610(k). However, the applicant's physician resubmitted the request with additional supporting documentation, triggering a new utilization review. This subsequent review certified the surgery as medically necessary, resolving the medical dispute. The Board denied reconsideration, holding that the defendant voluntarily submitted the resubmitted request, making the February 2, 2022 certification final and precluding further utilization review.
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