Miguel Alvarado — ADJ12791863

Applicant Miguel Alvarado claimed injury to his low back, right hip and digestive system while working as a cook; defendant accepted the low back and right hip. The dispute centered on whether the October 6, 2020 UR decision non-certifying a right total hip arthroplasty was timely and whether the Appeals Board or IMR had jurisdiction over the treatment dispute. The WCJ found the UR untimely, asserted jurisdiction, and appointed a 'regular physician' under Labor Code section 5701 to perform a UR determination of medical necessity. The Board granted reconsideration, holding the evidentiary record was incomplete because the underlying RFAs were not in evidence, precluding any substantial-evidence determination of UR timeliness. The Board also found the WCJ failed to address defendant's section 4610(k)/Rule 9792.9.1(h) argument that no UR was required because the same treatment was non-certified within the prior 12 months, and improperly ordered a 'second UR.' The Board rescinded the F&O and returned the matter to the trial level for further development of the record and a new decision.