CompFox AI Summary
The defendant, SCIF, sought reconsideration of an order requiring them to authorize specific medical treatment for the applicant, which had been denied by utilization review. SCIF argued the applicant failed to follow statutory procedures for dispute resolution regarding medical treatment. However, the Appeals Board denied reconsideration because SCIF waived this procedural defense by not raising it at trial. The sole issue litigated was the reasonableness of the medical treatment, for which the applicant presented substantial evidence. Therefore, the prior order mandating authorization of the treatment was upheld.
Full Decision Text1 Pages
The defendant, SCIF, sought reconsideration of an order requiring them to authorize specific medical treatment for the applicant, which had been denied by utilization review. SCIF argued the applicant failed to follow statutory procedures for dispute resolution regarding medical treatment. However, the Appeals Board denied reconsideration because SCIF waived this procedural defense by not raising it at trial. The sole issue litigated was the reasonableness of the medical treatment, for which the applicant presented substantial evidence. Therefore, the prior order mandating authorization of the treatment was upheld.
Read the full decision
Join + legal professionals. Create a free account to access the complete text of this decision and search our entire database.