- This was an accepted low back injury.
- DRE II – 9% after apportionment to preexisting injury.
- AME retro P&S’s him last year when he was evaluated.
- Tried to settle but AA gets treating reports to request surgery.
- Double fusion is requested. UR denies it. IMR is requested. While IMR is pending, treating doctor then requests single level fusion to same level. UR Partially certifies it. Then IMR comes down upholding first request.
AA files expedited hearing. We challenged our own UR for the single level fusion as invalid and challenged the second request of treating physician based on 4610(g)(6) because there was no evidence of a material change in the applicants condition and that applicant was trying to circumvent IMR.
For a copy of the full case, please click here.