What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration of the June 21, 2023 WCJ Joint Findings and Orders denying the IMR determination was based on a plainly erroneous fact
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.
Medical treatment / UR / IMRApplicant prevailedlumbar spine · knees
The IMR determination was based on a plainly erroneous factual finding regarding the applicant's symptoms, which the WCJ and WCAB found invalidated the IMR denial of surgery.
From the decision · page 2On June 21, 2023, the WCJ issued his Joint Findings and Orders, concluding that the IMR determination was invalid because it was based upon a plainly erroneous fact, and ordering the dispute resubmitted for a new IMR determination by a different reviewer. (Joint Findings and Orders, at p. 1.) In the Opinion on Decision, the WCJ explained that the denial of care was based upon the IMR reviewer's erroneous belief that applicant reported only right leg pain, whereas in fact the Clinical Case Summary referenced pain on the right and left sides, and that a straight leg raising test was bilaterally positive, i.e. on both the right and left sides. (Opinion on Decision, at pp. 3§ 4; Ex. 6, at pp. 2§ 3.) As such, the IMR reviewer's conclusion that the left-sided stenosis shown on the MRI did not correlate to applicant's symptoms was plainly erroneous. (Opinion on Decision, at pp. 3§ 4.)