CompFox AI Summary
This case involved a dispute over an applicant's entitlement to temporary disability benefits and recommended neck surgery following an admitted industrial injury. The employer sought reconsideration, arguing the medical evidence supporting the WCJ's award was insufficient and that a different statutory scheme for medical treatment disputes should apply. The Appeals Board found the employer's arguments regarding statutory interpretation unpersuasive and, critically, that the employer's utilization of the correct dispute resolution process for spinal surgery, specifically whether Utilization Review (UR) was properly conducted under Labor Code section 4610, was unclear. Consequently, the Board rescinded the WCJ's decision and remanded the case to the trial level to determine if the employer engaged in UR, instructing the WCJ to issue a new decision based on that determination and relevant case law.
Full Decision Text1 Pages
This case involved a dispute over an applicant's entitlement to temporary disability benefits and recommended neck surgery following an admitted industrial injury. The employer sought reconsideration, arguing the medical evidence supporting the WCJ's award was insufficient and that a different statutory scheme for medical treatment disputes should apply. The Appeals Board found the employer's arguments regarding statutory interpretation unpersuasive and, critically, that the employer's utilization of the correct dispute resolution process for spinal surgery, specifically whether Utilization Review (UR) was properly conducted under Labor Code section 4610, was unclear. Consequently, the Board rescinded the WCJ's decision and remanded the case to the trial level to determine if the employer engaged in UR, instructing the WCJ to issue a new decision based on that determination and relevant case law.
Read the full decision
Join + legal professionals. Create a free account to access the complete text of this decision and search our entire database.