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PanelDenied

Linda Banks — ADJ3198078

LINDA BANKS, Applicant vs. WELLS FARGO; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by its servicing facility, INTERCARE HOLDINGS INSURANCE SERVICES, INC. for INDUSTRIAL INDEMNITY/FREMONT COMPENSATION INSURANCE, in liquidation, Defendants

ADJ number: ADJ3198078
Decision date: Feb 28, 2021
District office: Sacramento
WCJ: Ariel Aldrich
Claim administrator: California Insurance Guarantee Association (CIGA) by its servicing facility Intercare Holdings Insurance Services, Inc. for Industrial Indemnity/Fremont Compensation Insurance, in liquidation
Commissioners: —

Injury / body parts: back, lower extremities

LC §4610.6

Summary

Applicant Linda Banks sustained an industrial back and lower extremity injury in 1992 while working for Wells Fargo. She challenged an IMR determination (CM20-0082231) that upheld utilization review's denial of one bilateral lumbar medial branch block at L3-4, L4-5, and L5-S1. Applicant argued there was a dichotomy between the MTUS and ODG guidelines and that the treatment was needed to address her posture and fall risk from long-term walker use. The WCAB denied reconsideration, adopting the WCJ's Report, holding that resolving discrepancies between the MTUS and ODG is outside the scope of an IMR appeal under Labor Code section 4610.6(h), and that applicant failed to prove by clear and convincing evidence any statutory ground to set aside the IMR determination.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.