CompFox AI Summary
This case involves an applicant seeking workers' compensation benefits for medical treatment recommended by her physician. The defendant contested responsibility, arguing a 2016 motor vehicle accident was the sole proximate cause of the need for treatment, not the applicant's 2002 industrial injury. The Board affirmed the finding that the treatment was at least partially related to the industrial injury but amended the order. This amendment defers the determination of medical necessity for the requested treatment pending further development of the record. Crucially, the defendant was precluded from utilizing the utilization review process due to their failure to properly notify the applicant and her attorney of their deferral decision.
Full Decision Text1 Pages
This case involves an applicant seeking workers' compensation benefits for medical treatment recommended by her physician. The defendant contested responsibility, arguing a 2016 motor vehicle accident was the sole proximate cause of the need for treatment, not the applicant's 2002 industrial injury. The Board affirmed the finding that the treatment was at least partially related to the industrial injury but amended the order. This amendment defers the determination of medical necessity for the requested treatment pending further development of the record. Crucially, the defendant was precluded from utilizing the utilization review process due to their failure to properly notify the applicant and her attorney of their deferral decision.
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