Hernandez, Manuel

Applicant Manuel Hernandez, a painter, sought authorization for medical treatment via an October 28, 2021 RFA issued by his PTP, Dr. David Patterson. Although the UR denial was untimely, conferring WCAB jurisdiction over medical necessity, the WCJ found applicant failed to meet his burden of proving the treatment was reasonably required by substantial medical evidence. Despite a year of court-ordered discovery to develop the record, applicant largely introduced older reports discussing 'similar' treatment modalities rather than the specific treatment at issue, while defendant obtained a rehabilitated peer review report addressing MTUS-ACOEM guidelines. The Appeals Board adopted and incorporated the WCJ's Report and Opinion (except the Verification/Signature section) and denied reconsideration.