Kathleen Baker — ADJ8969933

Applicant Kathleen Baker underwent L4-5 spinal fusion surgery on June 11, 2020, after her treating physician's RFA contained an error listing L5-S1 (which UR approved on April 29, 2020). When the level was corrected to L4-5, a second UR decision issued on June 10, 2020 denied the surgery, and IMR upheld that denial. The WCJ found the June 10, 2020 UR decision was not properly communicated to the doctor and that defendant knew or should have known the intended level was L4-5, holding defendant responsible for all surgery costs. The Appeals Board granted reconsideration and rescinded the F&A, holding the WCJ exceeded the Board's jurisdiction by adjudicating timeliness of the June 10 UR decision—an issue never framed for trial—which violated defendant's due process rights. The matter was remanded to the trial level for further proceedings to determine whether the June 10, 2020 UR decision was timely made and communicated.