CompFox AI Summary
In this workers' compensation case, the applicant sought renewed prescriptions for Norco and Omeprazole. Defendant contested the award of these medications, arguing the Workers' Compensation Appeals Board lacked jurisdiction due to a timely Utilization Review (UR) denial upheld by Independent Medical Review (IMR). The Board denied reconsideration, affirming the WCJ's award based on a stipulation agreement that waived the UR/IMR process in favor of an Agreed Medical Examiner (AME). The majority found defendant bound by the stipulation to abide by the AME's report, which deemed the prescriptions medically appropriate. A dissenting opinion argued the AME's report was insufficient for an award as it was not based on a current examination or complete review of the applicant's medical records.
Full Decision Text1 Pages
In this workers' compensation case, the applicant sought renewed prescriptions for Norco and Omeprazole. Defendant contested the award of these medications, arguing the Workers' Compensation Appeals Board lacked jurisdiction due to a timely Utilization Review (UR) denial upheld by Independent Medical Review (IMR). The Board denied reconsideration, affirming the WCJ's award based on a stipulation agreement that waived the UR/IMR process in favor of an Agreed Medical Examiner (AME). The majority found defendant bound by the stipulation to abide by the AME's report, which deemed the prescriptions medically appropriate. A dissenting opinion argued the AME's report was insufficient for an award as it was not based on a current examination or complete review of the applicant's medical records.
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