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PanelDenied

Hernandez, Lucila

LUCILA HERNANDEZ, Applicant vs. REGENTS OF THE UNIVERSITY OF CALIFORNIA, LOS ANGELES, permissibly self-insured administered by SEDGWICK, Defendants

ADJ number: ADJ17142305
Decision date: Date unavailable
District office: Los Angeles
WCJ: Jay W. Downey
Claim administrator: Sedgwick (administering for Regents of the University of California, Los Angeles, permissibly self-insured)
Commissioners: —

Injury / body parts: left knee

LC §4600LC §4610LC §4610.5LC §4610.6LC §4062

Summary

Applicant Lucila Hernandez sought one left knee Monovisc injection, which was non-certified by Utilization Review on February 17, 2023, and upheld on Independent Medical Review (IMR) by the Administrative Director on April 4, 2023. Applicant appealed the IMR determination, arguing it resulted from a plainly erroneous finding of fact, and sought to admit a post-review report from Dr. Miller dated March 22, 2023. The WCJ found that report inadmissible because it was obtained after the IMR review and was not part of the information submitted for IMR. The WCAB adopted the WCJ's report, found no clear and convincing evidence of a plainly erroneous fact, and denied reconsideration.

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

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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.