Gonzalez, Lilibeth

Applicant Lilibeth Gonzalez requested a laminectomy and discectomy for her industrial lumbar spine injury, which was denied through UR and upheld by an IMR determination on February 3, 2023. The IMR reviewer summarized applicant's condition as having only right-sided radiating leg pain and found that the MRI's left-sided stenosis did not correlate to her symptoms, when in fact applicant reported bilateral low back pain and had a positive bilateral straight leg raise test documented in the same letter. The WCJ found the IMR determination invalid because it rested on a plainly erroneous finding of fact and ordered a new IMR determination by a different reviewer. Defendant sought reconsideration, arguing the determination 'taken as a whole' was not plainly erroneous and that the reviewer could have denied care even with a correct understanding of the symptoms. The Board denied reconsideration, holding the IMR reviewer explicitly based the denial on the erroneous fact and that any theoretical possibility the reviewer might reach the same conclusion was irrelevant.