CompFox AI Summary
In this workers' compensation case, the applicant sought reconsideration of a decision denying their petition. The core issue was whether a February 2020 request for a cervical spine epidural injection constituted the "same treatment recommendation" as a previously denied September 2019 request, thereby preventing mandatory utilization review under LC § 4610(k). The Board denied reconsideration, adopting the WCJ's reasoning that the February 2020 request, while for one level instead of two, was for the "same treatment" at C5-C6 which had been denied within the prior 12 months. The Board further agreed that no documented change in facts material to the basis of the prior denial was presented, thus the Court lacked jurisdiction to determine the medical necessity of the treatment.
Full Decision Text1 Pages
In this workers' compensation case, the applicant sought reconsideration of a decision denying their petition. The core issue was whether a February 2020 request for a cervical spine epidural injection constituted the "same treatment recommendation" as a previously denied September 2019 request, thereby preventing mandatory utilization review under LC § 4610(k). The Board denied reconsideration, adopting the WCJ's reasoning that the February 2020 request, while for one level instead of two, was for the "same treatment" at C5-C6 which had been denied within the prior 12 months. The Board further agreed that no documented change in facts material to the basis of the prior denial was presented, thus the Court lacked jurisdiction to determine the medical necessity of the treatment.
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