CompFox AI Summary
The Workers' Compensation Appeals Board reconsidered a decision regarding Michael Coleman's entitlement to spinal surgery. The Board found that the defendant, TIG Specialty Insurance, failed to meet the strict procedural timelines required for objecting to a treating physician's surgical recommendation, specifically citing AD Rule 9792.6(o) and Labor Code section 4610(g)(1). Consequently, the Board rescinded the prior award and remanded the case, giving the defendant ten days to properly initiate the objection process for the spinal surgery. The Board also clarified that the Agreed Medical Evaluator was not qualified to perform the required second opinion surgery evaluation.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board reconsidered a decision regarding Michael Coleman's entitlement to spinal surgery. The Board found that the defendant, TIG Specialty Insurance, failed to meet the strict procedural timelines required for objecting to a treating physician's surgical recommendation, specifically citing AD Rule 9792.6(o) and Labor Code section 4610(g)(1). Consequently, the Board rescinded the prior award and remanded the case, giving the defendant ten days to properly initiate the objection process for the spinal surgery. The Board also clarified that the Agreed Medical Evaluator was not qualified to perform the required second opinion surgery evaluation.
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