ADJ16747878 — California WCAB decision

What the panel ordered

Findings and Order issued December 6, 2022 rescinded; matter returned to trial level for further proceedings consistent with this decision.

Petition for reconsideration granted to study factual and legal issues regarding medical necessity of orthovisc injections; matter returned to trial level for further proceedings.

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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 / IMRRemandedleft shoulder

The WCJ failed to adequately explain why the medical evidence did not rebut the MTUS guidelines; the Appeals Board found the record unclear and remanded for further development.

From the decision · page 5Because the record is unclear as to the WCJ's reasons or grounds for concluding that applicant failed to establish the medical necessity of the three series of orthodisc injections, we conclude that the record should be developed as to whether applicant is entitled to the requested treatment.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Applicant prevailed

Applicant's stipulation that the Utilization Review dated April 19, 2022 was untimely

From the decision · page 2On that same date, the matter proceeded to an expedited trial on the issue of whether "three series of orthovisc injections to the left shoulder are medically necessary." (Expedited Minutes of Hearing, November 28, 2022, p. 2:10.) The WCJ entered the parties' stipulation that "[t]he UR dated April 19, 2022, was untimely" into the record. (Id., p. 2:8.)

objective testingfavours Applicant prevailed

MRI showing advanced osteoarthritis and history of biceps repair; failure of conservative treatments

From the decision · page 3In this case, the claimant was seen regarding persistent pain throughout the left shoulder that was rated 8/10 with history of biceps repair. The review of the claimant's MRI also demonstrated advanced arthritic symptoms. Although MTUS guidelines do not have recognition for or against the use of Orthovisc injection; NCBI study states that these injections are typically utilized for local treatment of osteoarthritis and had promising results with or without rotator cuff tear for the shoulder. At this time, the claimant had failed conservative treatments including medication therapy, had history of biceps repair, and MRI also demonstrated advanced osteoarthritis. Orthovisc injection is reasonable, but a series of 3 injections is not recommended as claimant should have reevaluation performed to verify objective improvement with an initial injection. As such, the request is modified to 1 Orthovisc injection for the left shoulder. Therefore, the request for Orthovisc injections - 3 series injections to the left shoulder xl injection per week for three weeks, RFA dated 3/10/2022 is not medically necessary. However, 1 Orthovisc injection for the left shoulder is medically necessary.

treatment coursefavours Applicant prevailed

One orthovisc injection helped significantly according to Dr. Yacoubian's report

From the decision · page 4In his report dated July 27, 2022, Dr. Yacoubian indicates that the applicant had received one orthovisc injection, "which helped him significantly in the shoulder" (Applicant's Exhibit 3, page 1, EAMS Doc. I.D. 76174595).... Dr. Yakoubian provided no evidence to rebut the MTUS and the one UR doctor that approved one shot pointed to "promising" results in one NCBI study. (Report, pp. 1-4.)

ADJ16747878 · February 12, 2026

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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