CompFox AI Summary
This case concerns a dispute over the necessity of an anterior cruciate ligament (ACL) reconstruction surgery for an industrial knee injury. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's (ALJ) award of the surgery. The primary issue was the timeliness of the employer's utilization review (UR) denial of the proposed treatment. The WCAB found the UR decision invalid because it was issued outside the statutory timeframe after the request for authorization was received. Therefore, the proposed surgery was deemed authorized.
Full Decision Text1 Pages
This case concerns a dispute over the necessity of an anterior cruciate ligament (ACL) reconstruction surgery for an industrial knee injury. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's (ALJ) award of the surgery. The primary issue was the timeliness of the employer's utilization review (UR) denial of the proposed treatment. The WCAB found the UR decision invalid because it was issued outside the statutory timeframe after the request for authorization was received. Therefore, the proposed surgery was deemed authorized.
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