Cartagena, Carlos

Applicant Carlos Cartagena, a welder, was struck in the face by a metal bar, sustaining admitted injury to his lips and claimed injury to his mouth, teeth, gums, and face. After the treating MPN physician (Dr. Abdo) submitted an RFA for a dental referral, defendant deferred utilization review on a body-part dispute basis rather than submitting it to UR, but the deferral notice (Exhibit J1) was only served on the requesting physician, not the applicant and his attorney. The WCJ found in favor of lien claimant Dental Trauma Center, concluding the unrebutted medical evidence established a dental injury, the 12-month billing limitation was moot/inapplicable, and defendant was not entitled to retroactive UR because it failed to comply with AD Rule 9792.9. The Appeals Board adopted the WCJ's report and denied reconsideration, finding defendant did not meet its burden to show proper deferral of UR.