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PanelQMEDenied

Arciuch, Mark

MARK ARCIUCH, Applicant vs. NORTHRUP GRUMMAN SYSTEMS CORPORATION; AMERICAN HOME ASSURANCE COMPANY, Defendants

ADJ number: ADJ11584131
Decision date: Date unavailable
District office: Marina Del Rey
WCJ: Daniel Ter Veer
Claim administrator: American Home Assurance Company
Commissioners: —

Injury / body parts: lumbar spine, right shoulder, elbows, neck, lower extremities, hips

Summary

Applicant Mark Arciuch, a 60-year-old aircraft mechanic, sustained a cumulative industrial injury to his lumbar spine, right shoulder, and elbows. After a failed 2021 lumbar decompression surgery and multiple unsuccessful conservative treatments (physical therapy, medication, epidural injections, acupuncture), his PTP requested a second lumbar surgery via a 9/19/2023 RFA. The UR denial dated 10/2/2023 was found untimely, invalidating UR and removing the matter from IMR jurisdiction under Dubon II, permitting the WCJ to determine medical necessity based on substantial evidence. The WCJ awarded the surgery, finding the reports of Drs. Thomas and Gleiberman constituted substantial medical evidence meeting MTUS guidelines. The Appeals Board denied defendant's Petition for Reconsideration, adopting and incorporating the WCJ's Report.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.