CompFox AI Summary
The Appeals Board rescinded the WCJ's decision denying spinal surgery and returned the case for further proceedings, finding the defendant failed to conduct mandatory Utilization Review (UR) after a treating physician recommended surgery. The Board emphasized that per Sandhagen and Cervantes, defendants must follow strict UR and objection timelines for surgical requests. The WCJ was also directed to revisit the applicant's claims for medical mileage and penalties for non-payment of bills, as these issues were improperly deferred. The case will be decided anew by the WCJ, applying current legal standards.
Full Decision Text1 Pages
The Appeals Board rescinded the WCJ's decision denying spinal surgery and returned the case for further proceedings, finding the defendant failed to conduct mandatory Utilization Review (UR) after a treating physician recommended surgery. The Board emphasized that per Sandhagen and Cervantes, defendants must follow strict UR and objection timelines for surgical requests. The WCJ was also directed to revisit the applicant's claims for medical mileage and penalties for non-payment of bills, as these issues were improperly deferred. The case will be decided anew by the WCJ, applying current legal standards.
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