Michael Fishel — ADJ11053430

Applicant Michael Fishel sustained a lumbar spine injury on August 18, 2017, and his treating physician's RFAs for L5-S1 lumbar decompression and fusion were repeatedly denied through UR and upheld by IMR. At a February 3, 2020 expedited hearing, rather than litigate, the parties entered into a stipulation that defendants would authorize an MRI and submit the need for spinal surgery to PQME Dr. Gumbs for opinion on reasonableness and necessity, with WCAB jurisdiction reserved; a subsequent MOH reflected defense counsel's representation that surgery would be authorized if a psych doctor cleared applicant. The WCJ found the parties had waived the UR/IMR process for the lumbar surgery and issued a Findings and Award deferring the surgery determination to PQME Gumbs and Dr. Dorsey, with an award of further medical care. Defendant petitioned for reconsideration arguing the court acted in excess of power. The Board granted reconsideration solely to remove the award and replace it with an order deferring the surgery authorization determination to the QME and Dr. Dorsey in lieu of UR/IMR, otherwise affirming the WCJ's analysis.