Applicant Arthur Orcutt, a driver, sustained an accepted industrial injury to numerous body parts. A dispute arose over his entitlement to a left total knee arthroplasty and related treatment requested in Dr. McCandless's September 21, 2022 RFA. The WCJ found the UR denial untimely because defendant's request for additional information under Labor Code §4610(g)(1) was deficient (no specificity, no box checked) and thus did not toll the 5-working-day determination period, and further found the treatment reasonable and necessary under Labor Code §4600 and MTUS/ACOEM guidelines. Defendant filed a Petition for Reconsideration which the WCJ deemed untimely; however, the WCAB found the petition timely because mail service to applicant and the Kentucky-based TPA extended the filing deadline. The Board denied reconsideration, adopting and incorporating the WCJ's report.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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