What the panel ordered
Petition for Reconsideration denied.
Lien claimant RMS Medical filed a timely, verified Petition for Reconsideration from the Amended Findings and Order issued February 23, 2024.
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.
Lien claimant RMS Medical was not within the defendant's medical provider network and the reports by Dr. Gottschalk did not prove or disprove a disputed medical fact essential to adjudication of the applicant's claim for benefits. Disputes regarding denial of a specific treatment protocol must be resolved through utilization review and independent medical review, not by a treating physician or panel QME. Therefore, lien claimant is not entitled to reimbursement for medical treatment or medical-legal expenses.
From the decision · page 5The lien claimant acknowledged they were not within the defendant's medical provider network. (See petition for petition for reconsideration p. 3 ll. 19) Based on the current record the undersigned found lien claimant is not entitled reimbursement for medical treatment cost.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.