CompFox AI Summary
The Workers' Compensation Appeals Board granted reconsideration and affirmed the finding that the defendant's utilization review (UR) denials were untimely served, rendering them invalid. As a result, the Board found the requested medications, Norco and Pennsaid, to be reasonably necessary based on substantial medical evidence from the applicant's physician. However, the Board limited Norco refills to five, acknowledging that ongoing opioid use requires periodic review, unlike the nurse case manager services in a prior case. The case was returned to the trial level for further proceedings.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board granted reconsideration and affirmed the finding that the defendant's utilization review (UR) denials were untimely served, rendering them invalid. As a result, the Board found the requested medications, Norco and Pennsaid, to be reasonably necessary based on substantial medical evidence from the applicant's physician. However, the Board limited Norco refills to five, acknowledging that ongoing opioid use requires periodic review, unlike the nurse case manager services in a prior case. The case was returned to the trial level for further proceedings.
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