CompFox AI Summary
The Appeals Board rescinded the original WCJ's decision, finding the applicant's appeal of the UR denial for spinal surgery is denied. The Board clarified that a procedural defect in a UR report, such as an illegible signature, does not invalidate the UR determination unless the UR itself was untimely. Since the parties stipulated the UR was timely, the Board lacked jurisdiction to determine the medical necessity of the surgery. Therefore, the IMR decision upholding the UR denial stands, and the applicant's request for surgery is denied.
Full Decision Text1 Pages
The Appeals Board rescinded the original WCJ's decision, finding the applicant's appeal of the UR denial for spinal surgery is denied. The Board clarified that a procedural defect in a UR report, such as an illegible signature, does not invalidate the UR determination unless the UR itself was untimely. Since the parties stipulated the UR was timely, the Board lacked jurisdiction to determine the medical necessity of the surgery. Therefore, the IMR decision upholding the UR denial stands, and the applicant's request for surgery is denied.
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