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PanelDenied

Julie Wyatt — ADJ3670956

JULIE WYATT, Applicant vs. SODEXHO; THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, ADMINISTERED BY GALLAGHER BASSETT SERVICES, INC, Defendants

ADJ number: ADJ3670956
Decision date: Mar 12, 2023
District office: Stockton
WCJ: —
Claim administrator: Gallagher Bassett Services, Inc. (administering The Insurance Company of the State of Pennsylvania)
Commissioners: —

Injury / body parts: Back

LC §4604.5

Summary

Applicant Julie Wyatt sustained a stipulated back injury on April 19, 2002, which settled in 2004 with an award of future medical treatment. After an RFA for the muscle relaxant Zanaflex on April 29, 2022, the Utilization Review denial was stipulated to be untimely, and IMR upheld the UR denial on June 22, 2022. The WCJ found that because the UR was untimely, the WCAB had jurisdiction under Dubon to determine medical necessity, and relying on Dr. Fine's substantial medical evidence, found Zanaflex medically necessary under MTUS guidelines. The WCJ awarded the medication, attorney fees, and a 25% penalty for unreasonable delay of medical benefits. Defendant petitioned for reconsideration, and the Board adopted the WCJ's report and denied the petition.

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.