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PanelGranted in Part

Mark Erhardt — ADJ11054418

MARK ERHARDT, Applicant vs. U.S. CONCRETE dba CENTRAL CONCRETE SUPPLY COMPANY, INC. permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number: ADJ11054418
Decision date: Jul 21, 2022
District office: Salinas
WCJ: —
Claim administrator: Sedgwick Claims Management Services (administering for U.S. Concrete dba Central Concrete Supply Company, Inc., permissibly self-insured)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: left knee, right knee

LC §4600LC §5952CCR §10109CCR §10945

Summary

Applicant Mark Erhardt, a concrete mixer driver, claimed a September 5, 2017 left knee injury. His authorized PTP Dr. Harwood issued an October 20, 2021 PR-2/RFA requesting left knee arthroscopy and a right knee MRI, but defendant did not submit it to Utilization Review. The WCJ found defendant failed to timely deny the RFA and ordered authorization of the surgery and MRI. On reconsideration, the Board affirmed that defendant did not timely conduct UR (because defense counsel received the RFA and had a duty to forward it, and Dr. Brown's reports gave notice that further investigation was needed), but amended the F&O to defer the issue of whether the treatment was reasonable and necessary because the only supporting medical report (Dr. Harwood's PR-2/RFA) did not explain the reasoning and was not substantial evidence. The matter was returned to the WCJ to develop the record.

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.