The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
otherRelied upon · psychology
Diagnosed Minor Neurocognitive Disorder from the January 11, 2018 industrial motor vehicle accident, noting cognitive weaknesses and severe depression and anxiety related to chronic pain and sleep issues, recommending psychotherapeutic services and psychiatric consultation.
From the decision · page 2(MOH/SOE, 11/16/2022, 2:14-22.)
In his report dated March 31, 2022, Fernando Gonzalez, Ph.D., after his evaluation of
PTPRelied upon
Requested inpatient evaluation at Casa Colina Apple Valley for traumatic brain injury, citing objective clinical markers of impairment including abnormal memory tests and MRI findings.
His RFA was central to the timeliness dispute of the UR denial.
From the decision · page 3Dr. Bertoldi requested in his RFA "Inpatient evaluation Casa Colina Apple Valley" dated
May 25, 2022 to address applicant's traumatic brain injury. (App. Ex. 3, p. 3). In the accompanying
primary treating physician's progress report dated May 25, 2022, Dr. Bertoldi identified several
objective clinical markers of impairment, including "abnormal" long and short-term memory,
an abnormal Mini-Mental State Examination score of 23/30, and a 3 Tesla MRI showing
posttraumatic Unidentified Bright Objects. (Id. at p. 2.) He supported the request for evaluation at
Casa Colina Apple Valley by citing applicant's memory and concentration problems. (Ibid.)
Dr. Bertoldi faxed the RFA on May 27, 2022. (Id. at p. 1.)
otherRelied upon · medicine
Reviewed medical records and denied the RFA on June 10, 2022, noting no response to the June 6, 2022 request for additional information.
His review and denial formed the basis of the timeliness dispute.
From the decision · page 4On June 10, 2022, defendant issued a "Notice of Modified Physician Determination,"
denying Dr. Bertoldi's RFA for an inpatient evaluation at Casa Colina Apple Valley. (Joint Ex. Z,
p. 1.) The Notice is addressed to Dr. Bertoldi at his mailing address and lists his telephone and fax
numbers. There is no indication how it was sent to Dr. Bertoldi. Under "Distribution," it states:
"Applicant Attorney: Solov Teitell (via mail)" and "Employee: the applicant (via mail). (Id. at
pp. 1-2.) The review by Mahdy Flores, D.O., stated that the date of service was June 10, 2022, and
that the following medical records were reviewed: "Letter-UR_MD_Request (2 pgs)" and
"05/25/22 RFA- Roger Bertoldi, MD (2 pgs)." It states that the Request for Information letter
was reviewed, but it states that "a response was not submitted for this review." (Id. at p. 3.)