CA: WCAB Further Refines Utilization Review Spinal Surgery Procedures

Jacob Vervalin v. Mission Uniform & Linen, Travelers Insurance

Medical-Legal Procedure--Spinal Surgery--WCAB rescinded WCJ's finding that applicant/sales representative with 4/20/2007 spinal injury was entitled to spinal surgery based upon AME's report, when WCAB found that it was improper for WCJ to rely on Labor Code § 4062.3(j) and supplemental AME report to authorize spinal surgery, that proper procedures governing objections to a treating physician's recommendation for spinal surgery are set forth in Labor Code §§ 4610 and 4062, as explained in Cervantes v. El Aguila Food Products, Inc. (2009) 74 Cal. Comp. Cases 1336 (Appeals Board en banc opinion), and that, in keeping with proper procedures, WCJ was required to rely either on treating physician's report or second opinion report obtained by defendant pursuant to Labor Code § 4062(b); WCAB, having found that there was not substantial medical evidence in record upon which WCJ could base a decision regarding applicant's entitlement to spinal surgery, remanded matter for further development  of the medical record pursuant to Cervantes and Labor Code § 4062(b). © Copyrighted 2010 by LexisNexis. All rights reserved.

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Source: Calif. Workers’ Compensation Appeals Board