Juan Gonzalez — ADJ12516127

Applicant Juan Gonzalez sustained crush injuries to his pelvis, femoral artery, and abdomen while working as a pipe layer on June 3, 2019. After UR non-certified Dr. Clark Smith's 8/22/2021 RFA for a pre-surgical consult for an intrathecal pump, applicant's primary treating physician Dr. Jean-Jacques Abitbol submitted a separate RFA on 9/3/2021 for the same pre-surgical consult marked for expedited review. The WCJ found the defendant's UR of Dr. Abitbol's RFA was untimely (the 72-hour expedited timeframe applied but was not met), and that Labor Code section 4610(k)'s 12-month moratorium did not apply because Dr. Abitbol and Dr. Smith were not the same physician or in the same practice group. The WCJ awarded the pre-surgical consult but denied the requested Zolgensma medication for failure to meet the burden of proof. The Board adopted and incorporated the WCJ's Report and Opinion and denied reconsideration, holding the plain, unambiguous language of section 4610(k) controlled.