CompFox AI Summary
The Appeals Board granted the applicant's petition for removal, finding that the administrative law judge (WCJ) erred in ruling the Utilization Review (UR) decision timely. The defendant's UR did not address the physician's request for repair or replacement of the applicant's motorized scooter, instead questioning the general medical necessity of a scooter. Because the UR was invalid as it failed to address the actual request, the Appeals Board has jurisdiction. The case is returned to the trial level for a determination of medical necessity based on substantial evidence, and for a ruling on the admissibility of evidence.
Full Decision Text1 Pages
The Appeals Board granted the applicant's petition for removal, finding that the administrative law judge (WCJ) erred in ruling the Utilization Review (UR) decision timely. The defendant's UR did not address the physician's request for repair or replacement of the applicant's motorized scooter, instead questioning the general medical necessity of a scooter. Because the UR was invalid as it failed to address the actual request, the Appeals Board has jurisdiction. The case is returned to the trial level for a determination of medical necessity based on substantial evidence, and for a ruling on the admissibility of evidence.
Read the full decision
Join + legal professionals. Create a free account to access the complete text of this decision and search our entire database.