What the panel ordered
The Appeals Board rescinded the May 6, 2004 WCJ decision and remanded the matter to the WCJ to allow the defendant a reasonable time to initiate the AME/QME procedure and for the WCJ to redetermine the applicant's entitlement to right shoulder surgery after completion of the AME/QME procedure.
The Appeals Board granted reconsideration of the May 6, 2004 Findings and Award issued by the workers' compensation administrative law judge (WCJ) to further study the record and applicable law.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Appeals Board held that utilization review physician's reports are admissible only for determining medical necessity, not causation, and that the defendant must initiate the AME/QME procedure if causation is questioned. The WCJ's prior decision was rescinded and the matter remanded for the defendant to initiate the AME/QME procedure and for redetermination of entitlement to surgery.
From the decision · page 410 Here, the WCJ's May 6, 2004 decision finding that right shoulder surgery is necessary to