RAITO, INC.; TIG SPECIALTY INSURANCE CO.; and RISK ENTERPRISE MANAGEMENT, LTD. (Adjusting Agent), MICHAEL COLEMAN, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAMICHAEL COLEMAN, Applicant,vs.RAITO, INC.; TIG SPECIALTY INSURANCE CO.; and RISK ENTERPRISE MANAGEMENT, LTD. (Adjusting Agent), Defendant(s).Case No. ADJ3308341 (OAK 0279019)OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION Defendant, TIG Specialty Insurance Company, by and through its adjusting agent, Risk Enterprise Management, Ltd., has filed a petition seeking reconsideration of the Findings of Fact and Award issued by the workers’ compensation administrative law judge (WCJ) on July 27, 2009. In that decision, the WCJ determined that applicant, Michael Coleman, is entitled to further medical treatment, including the spinal surgery recommended by applicant’s treating physician, Kenneth I. Light, M.D. In her Opinion on Decision, the WCJ acknowledged that defendant is “correct” that the November 13, 2008, December 4, 2008, and February 5, 2009 reports of Dr. Light were not “clearly marked at the top” that they were requesting authorization for spinal surgery, as required by Administrative Director (AD) Rule 9792.6(o). (Cal. Code Regs., tit. 8, § 9792.6(o).) However, the WCJ stated that defendant obtained a utilization review (UR) report from William H. Milnor, M.D., dated April 29, 2009, which denied the recommended surgery. Therefore, the WCJ concluded that defendant “must have been aware” of 1itthe requests for surgery. Accordingly, the WCJ found that defendant’s UR denial was untimely under Labor Code section 4610(g)(1)1 because it did not issue either within five working days of defendant’s receipt of Dr. Light’s reports or within 14 days from the date Dr. Light first 1All further statutory references are to the Labor Code, , recommended spinal surgery. Further, defendant did not object to Dr. Light’s first report recommending surgery within 10 days of its receipt, so defendant
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