Daniel Servin — ADJ11423609

Applicant Daniel Servin sustained an admitted left shoulder injury while working as an Auto Body Technician for Cerritos Lexus. His treating physician, Dr. Omid, submitted an RFA for reverse total shoulder arthroplasty that was non-certified by utilization review on January 11, 2022 for lack of imaging studies. Dr. Omid resubmitted the RFA on January 27, 2022, marked 'Resubmission - Change in Material Facts,' attaching the previously missing imaging studies, and UR certified the surgery as medically necessary on February 2, 2022. Defendant then issued a February 7, 2022 UR decision disclaiming its prior certification, and after the WCJ ordered authorization, sought reconsideration arguing the January 11, 2022 non-certification was binding for 12 months under section 4610(k). The Board denied reconsideration, holding that defendant voluntarily submitted the matter for further UR (rather than declining under 4610(k)), the February 2, 2022 certification resolved the medical dispute, and the subsequent February 7, 2022 UR was statutorily impermissible.