What the panel ordered
Dismissal of applicant's Petition for Reconsideration after admitting the February 10, 2020 IMR determination into evidence
Petition for Reconsideration of the Findings of Fact, Orders and Opinion on Decision issued by the WCJ on January 10, 2020
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 IMR determination overturned the Utilization Review denial and required the defendant to provide the surgical consultation, so the applicant was not aggrieved by the WCJ's Findings of Fact, Orders and Opinion on Decision.
From the decision · page 1Request for an authorization for an orthopedic surgical consult that was made by Dr. Annu Navani, M.D. with a report written by physician's assistant Corey Tremblay specifically requesting an orthopedic surgical consultation for the right shoulder. There were other items requested at the same time, but we're only dealing with the authorization request for the orthopedic surgical consult for the right shoulder which was non-certified by the Utilization Review company Genex on December 3, 2019.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The February 10, 2020 IMR determination overturned the Utilization Review denial of the surgical consultation request.
Favours Defendant prevailed
This meant the defendant was obligated to provide the surgical consultation, so the applicant was not aggrieved by the WCJ's Findings of Fact, Orders and Opinion on Decision.
From the decision · page 2The F&O ordered the parties to proceed with IMR of the UR decision regarding the surgical consultation. Review of the subsequent IMR determination reveals that defendant's December 3, 2019 UR decision was overturned. Defendant is consequently obligated to provide the recommended surgical consultation irrespective of whether this treatment recommendation was subject to UR. Therefore, applicant is not aggrieved by the F&O since she is entitled to the surgical consultation per the IMR determination and her Petition will be dismissed. (Lab. Code, § 5903.)
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Requested an orthopedic surgical consultation for the right shoulder.
From the decision · page 1Request for an authorization for an orthopedic surgical consult that was made by Dr. Annu Navani, M.D. with a report written by physician's assistant Corey Tremblay specifically requesting an orthopedic surgical consultation for the right shoulder. There were other items requested at the same time, but we're only dealing with the authorization request for the orthopedic surgical consult for the right shoulder which was non-certified by the Utilization Review company Genex on December 3, 2019.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, § 5903
Labor Code section 5903
The IMR determination requires the defendant to provide the recommended surgical consultation irrespective of whether the treatment recommendation was subject to Utilization Review.
From the decision · page 2The F&O ordered the parties to proceed with IMR of the UR decision regarding the surgical consultation. Review of the subsequent IMR determination reveals that defendant's December 3, 2019 UR decision was overturned. Defendant is consequently obligated to provide the recommended surgical consultation irrespective of whether this treatment recommendation was subject to UR. Therefore, applicant is not aggrieved by the F&O since she is entitled to the surgical consultation per the IMR determination and her Petition will be dismissed. (Lab. Code, § 5903.)
What proof carried it
The evidence the panel weighed, by kind.
February 10, 2020 IMR determination overturning the December 3, 2019 Utilization Review denial
From the decision · page 2The F&O ordered the parties to proceed with IMR of the UR decision regarding the surgical consultation. Review of the subsequent IMR determination reveals that defendant's December 3, 2019 UR decision was overturned. Defendant is consequently obligated to provide the recommended surgical consultation irrespective of whether this treatment recommendation was subject to UR. Therefore, applicant is not aggrieved by the F&O since she is entitled to the surgical consultation per the IMR determination and her Petition will be dismissed. (Lab. Code, § 5903.)
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
- If you are named in this decision and want this page removed, write to privacy@similarcase.com.