Sandra Ceja — ADJ11862779

Applicant Sandra Ceja sustained an industrial injury to her right knee while working as a laborer for Taylor Farms Pacific. Her orthopedic surgeon, Dr. Jupina, recommended a right knee arthroscopy with partial medial menisectomy. Defendant's UR decision non-certifying the surgery was found untimely because it was not served on applicant's attorney, giving the WCAB jurisdiction over medical necessity. However, the WCJ found—and the majority affirmed—that applicant failed to meet her burden of proving the surgery was medically necessary because Dr. Jupina's reports lacked citations to the MTUS or evidence-based guidelines and merely summarized conversations with the applicant. Commissioner Snellings concurred on the UR timeliness but dissented, arguing the record should be developed further rather than denying potentially necessary treatment.