CompFox AI Summary
The Workers' Compensation Appeals Board (WCAB) reversed a prior decision by an administrative law judge (WCJ) that had remanded five Independent Medical Review (IMR) determinations for new reviews. The WCAB found that the WCJ erred in determining that the IMR reviews were invalid simply because they did not list the specific dates and authors of all reviewed medical records. The Board concluded that the IMR determinations sufficiently identified reviewed documents and that the WCJ could not substitute her own medical necessity judgment for that of the IMR. Therefore, the five IMR determinations are now considered final and binding, denying the applicant's requested medical treatments.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board (WCAB) reversed a prior decision by an administrative law judge (WCJ) that had remanded five Independent Medical Review (IMR) determinations for new reviews. The WCAB found that the WCJ erred in determining that the IMR reviews were invalid simply because they did not list the specific dates and authors of all reviewed medical records. The Board concluded that the IMR determinations sufficiently identified reviewed documents and that the WCJ could not substitute her own medical necessity judgment for that of the IMR. Therefore, the five IMR determinations are now considered final and binding, denying the applicant's requested medical treatments.
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