CompFox AI Summary
The Workers' Compensation Appeals Board granted reconsideration of a prior decision concerning applicant Leonardo Nungaray's claim. The Board found that the initial Utilization Review (UR) determination erroneously characterized the applicant's requested treatment for a left-sided epidural injection as a right-sided procedure. This fundamental error in the UR process, not the Independent Medical Review (IMR), requires further examination. Consequently, the case is returned to the trial level to determine if the UR was timely and if the judge has jurisdiction over the medical necessity dispute.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board granted reconsideration of a prior decision concerning applicant Leonardo Nungaray's claim. The Board found that the initial Utilization Review (UR) determination erroneously characterized the applicant's requested treatment for a left-sided epidural injection as a right-sided procedure. This fundamental error in the UR process, not the Independent Medical Review (IMR), requires further examination. Consequently, the case is returned to the trial level to determine if the UR was timely and if the judge has jurisdiction over the medical necessity dispute.
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