Jeffrey Dixon vs. Falcon Trading Co., Inc.; State Compensation Insurance Fund

This case involves Jeffrey Dixon, who was found to have incurred an industrial injury to his back and knees. In 2010, his treating physician, Dr. Charlicl Nahm, requested authorization to re-initiate the use of opioid medication to control his symptoms of pain, and to obtain an MRI to assess his worsening condition. The State Compensation Insurance Fund (SCIF) submitted the requests to utilization review (UR) and denied authorization based upon the UR reports. Dixon then filed a Declaration of Readiness to Proceed on the issue of entitlement to medical treatment and the issue was tried on August 9, 2010. The WCJ found that the requested treatment was reasonable and necessary to cure and relieve from the effects of the industrial injury and ordered SCIF

Falcon Trading Co., Inc.; State Compensation Insurance Fund Jeffrey Dixon WORKERS-COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAJEFFREY DIXON, Applicant, vs.FALCON TRADING CO., INC.; STATE COMPENSATION INSURANCE FUND, Defendants.Case No. ADJ3796500 (SAL 053560)OPINION AND ORDER DENYING RECONSIDERATION Defendant State Compensation Insurance Fund (SCIF) seeks reconsideration of the August 11, 2010 Findings and Order of the workers’ compensation administrative law judge (WCJ) who found, “‘The Oxycontin and drug screening and the MRI of the lumbar spine as prescribed by [applicant’s treating physician] Dr. [Charlicl Nahm are reasonable and necessary to cure and relieve from the effects of the industrial injuryand ordered defendant to provide those items. (Bracketed material added.) It was earlier found that applicant incurred industrial injury to his back and to his knees and medical treatment was awarded.            SCIF contends that the requested treatment should have been denied based upon its utilization review (UR) because applicant did not seek an Agreed Medical Examiner (AME) pursuant to Labor Code sections 4062 and 4062.2 before proceeding to an expedited hearing.1 1 Further statutory references arc to the Labor Code. Section 4062 provides in pertinent pari: “If the employee objects lo a decision made pursuant to Section 4610 to modify, delay, or deny a treatment recommendation, the employee shall notify the employer of the objection in writing within 20 days of receipt of that decision. These time limits may be extended for good cause or by mutual agreement. If the employee is represented by an attorney, a medical evaluation to determine the disputed medical issue shall be obtained as provided in Section 4062.2. and no other medical evaluation shall be obtained.”Section 4062.2(b) provides in pertinent pan: ‘The panics shall seek agreement with the other pany on the physician, who need not be a qualified medical evaluator, to prepare a repon resolving the disput

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