What the panel ordered
The Appeals Board affirmed the Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration issued on May 20, 2019, denying penalties for unreasonable delay in benefits for the left shoulder injury.
Applicant sought reconsideration of the amended decision issued by the Appeals Board on May 20, 2019, which granted defendant's Petition for Reconsideration and amended the Findings and Award.
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.
Defendant's denial of treatment was based on a genuine medical doubt created by the replacement QME's opinion that the left shoulder injury was not industrially related, making the delay reasonable and not warranting penalties.
From the decision · page 6We are unpersuaded that defendant's denial of treatment for this body part was unreasonable under the circumstances in this case. The proof of service for Dr. Banes' report shows that it was served on the parties the day before the surgery was authorized on May 17, 2018. Accounting for at least five days for mailing,2 it may be presumed that defendant received Dr. Banes' report shortly after its UR decision issued. Dr. Banes' conclusion that applicant's left shoulder condition was not industrially related created a genuine doubt as to defendant's liability for benefits for this body part. Defendant's delay in providing treatment following receipt of Dr. Banes' report was not without a reasonable basis such that penalties are warranted.