CA: WCAB Finds Utilization Report Raised No Question of Causation of Need for Requested Surgery

Martha Zamora v. Culinary Specialties, Inc., Pennsylvania Manufacturers'  Association Insurance Company

Medical Treatment--Utilization Review--WCAB affirmed WCJ's award of medical treatment in form of right shoulder surgery to applicant/mixer with 7/13/2007 right shoulder injury, and held that (1) pursuant to Simmons v. State of California (2005) 70 Cal. Comp. Cases 866 (Appeals Board en banc opinion), a defendant may only contest issue of causation of need for medical treatment requested by treating physician if utilization review (UR) physician identifies causation as an issue in UR report, (2) here, UR physician raised no question regarding causation of applicant's need for requested surgery, and (3) there was no other evidence in record raising issue about industrial causation of need for shoulder surgery. © Copyrighted 2010 by LexisNexis. All rights reserved.

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Source: Calif. Workers’ Compensation Appeals Board