What the panel ordered
The WCAB rescinded the April 5, 2021 decision and returned the matter to the WCJ for further proceedings and a new decision consistent with the opinion that defendant improperly discontinued medical transportation services without proper medical support and UR process.
Applicant sought reconsideration of the Findings and Order issued by a workers' compensation administrative law judge (WCJ) on April 5, 2021, which found no jurisdiction over the reasonableness and medical necessity of discontinued wheelchair transportation services due to utilization review (UR) and Independent Medical Review (IMR). The WCAB granted reconsideration to study the factual and legal issues further.
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 WCAB found that defendant improperly terminated medical transportation services without medical evidence of changed condition and without proper utilization review, requiring continuation of services until a proper UR determination is made.
From the decision · page 3On December 9, 2020, the matter proceeded to an expedited hearing. The issues for adjudication were the need for future medical treatment in the form of medical transportation to medical appointments, whether the WCAB has jurisdiction over the transportation dispute in light of the November 5, 2020 UR denial, and whether there was good cause to terminate wheelchair transportation services in October 2020.