What the panel ordered
February 27, 2014 en banc decision rescinded; Petition for Reconsideration filed by applicant denied; September 20, 2013 Findings and Order of WCJ affirmed
Petition for Reconsideration filed by State Compensation Insurance Fund (SCIF) granted; prior en banc decision rescinded and matter remanded to WCJ for further proceedings on medical necessity of spinal surgery
This docket was decided more than once. Shown here is the latest released decision; we also hold May 22, 2014, February 27, 2014.
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 Board held that if a UR decision is timely and valid, medical necessity is resolved by IMR; if untimely, medical necessity is determined by the WCAB based on substantial medical evidence.
From the decision · page 1617 E. IF A UR DECISION IS UNTIMELY, THE DETERMINATION OF MEDICAL NECESSITY MAY BE MADE BY THE WCAB BASED ON SUBSTANTIAL MEDICAL EVIDENCE