Kathleen Czarnecki

Applicant Kathleen Czarnecki, a claims examiner, sustained an admitted injury to her neck, right shoulder, and right upper extremity. Her treating physician, Dr. McClurg, recommended a second shoulder surgery (open Mumford/distal clavicle resection), which defendant Golden Eagle refused to authorize based on reports from non-examining physicians at Physician Authorization Review, Inc. (utilization review). After an expedited hearing, the WCR excluded the UR reports because they were prepared without a physical examination and awarded the recommended treatment. On reconsideration, the Board affirmed, holding that reports by physicians who never physically examined the applicant are inadmissible under Labor Code section 5703, and that the Administrative Director's utilization review regulation (Rule 9792.6) cannot override the statutory AME/QME dispute-resolution process required by Labor Code section 4062. Defendant's petition was denied.