What the panel ordered
Petition for Reconsideration denied by the Appeals Board panel.
Petition for Reconsideration filed by Defendant after Administrative Director's Final Determination on Independent Medical Review was remanded for further review.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Administrative Director's September 16, 2022 determination contained a mistake of fact as a matter of ordinary knowledge, entitling applicant to a third independent medical review on lymphatic massage treatment.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The Administrative Director's September 16, 2022 determination contained inconsistent statements and a mistake of fact as a matter of ordinary knowledge regarding applicant's home treatment for lymphedema.
Favours Applicant prevailed
This mistake of fact justified setting aside the determination and ordering a third independent medical review.