Elaine Holguin — ADJ2529637

Applicant, a pre-school teacher, sustained an admitted 2005 injury to multiple body parts, resolved by a Compromise and Release with open future medical treatment. Treating physician Dr. Small requested a Functional Restoration Program in an August 27, 2021 RFA, which was denied by UR on September 3, 2021 and upheld by IMR on October 12, 2021. Dr. Small then submitted a September 13, 2021 RFA labeled a 'Resubmission - Change in Material Facts.' The WCJ found UR was required on the resubmission and awarded the program; defendant sought reconsideration. The Appeals Board rescinded the F&A, finding that Dr. Small's September 13, 2021 report merely disputed the UR doctor's reasoning rather than documenting any change in material facts, so it was not substantial evidence and UR was not required; applicant was therefore not entitled to the program at defendant's expense.