Applicant Jesus Macias Macedo, a construction foreman injured on September 26, 2016, and defendant both sought reconsideration of a November 15, 2019 F&O in which the WCJ found six UR decisions untimely, awarded medical treatment including the denied modalities, and awarded penalties under Labor Code section 5814.5. The Board granted reconsideration and rescinded the F&O, conducting a day-by-day timeliness analysis (excluding the receipt day, weekends, and holidays per AD Rule 9792.9.1 and Pa'u) and concluding that all UR decisions in dispute were timely issued and communicated. Because the UR decisions were timely, the Board held it lacked jurisdiction under Dubon II to address medical necessity, which must be resolved through IMR. The Board further found defendant was not required to conduct UR of Dr. Lamm's 'voluntary appeal' under section 4610(k), and that applicant failed to meet his burden to prove unreasonable delay supporting penalties under section 5814 or attorney's fees under section 5814.5. A general award of future medical treatment was issued for the stipulated AOE/COE body parts.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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