Applicant Linda Medina, a labeler who sustained an accepted lumbar spine injury on February 3, 2022, sought review of a July 22, 2025 IMR determination that upheld a May 20, 2025 UR denial of lumbar fusion/decompression surgery requested by her PTP Dr. Hannani. Applicant argued the IMR was based on a plainly erroneous finding of fact regarding the absence of evidence of 'concomitant instability,' and that Dr. Hannani's June 2, 2025 report constituted a material change in circumstances requiring a new UR. The WCJ found that the June 2, 2025 report was never submitted to IMR, that applicant identified no report reviewed by IMR containing a plainly erroneous fact, and that the June 2, 2025 report was essentially identical to the May 9, 2025 report and showed no material change in condition. The Appeals Board adopted and incorporated the WCJ's Report and Opinion on Decision and denied reconsideration.
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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The panel considered the record, the applicable statutes, and the arguments of the parties.
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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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