Rodolfo Arroyo sustained industrial injury in 2000 to his back, knees and right big toe while working for Inland Concrete Enterprises as a concrete worker. The parties’ Agreed Medical Evaluator (AME) Stuart Green, M.D., testified at his deposition in 2008 that it was medically reasonable for applicant to use a motorized scooter to relieve the effects of his industrial injury. Dr. Green reiterated that opinion in his comprehensive March 12, 2009 report of examination. Defendant accepted the opinion of the AME and provided applicant with a motorized scooter.
After approximately five years of use, the scooter began to break down. On February to, 2015, applicant’s primary treating physician Jalil Rashti, M.D., reported to defendant that applicant’s scooter was broken and he requested authorization to replace it with a new scooter in light of the costs of repair.
Defendant submitted the request for authorization to UR. However, the UR reviewer did not evaluate whether the scooter should be replaced or repaired. Instead, the timely UR decision addressed whether Arroyo should use a motorized scooter as a matter of medical necessity, and denied authorization to purchase one on the grounds that it was “not essential to care.”
Applicant requested a hearing to challenge defendant’s action, and the issues of “(n]eed for further medical treatment in the form of a motorized scooter” and “[s]ubject matter jurisdiction over the medical treatment dispute” were tried before the WCJ who issued his decision finding that the WCAB lacked subject matter jurisdiction over the treatment dispute because defendant issued a timely UR decision. The WCAB granted a petition for reconsideration and reversed this finding in the panel decision of Arroyo v Inland Concrete Enterprises.
The panel concluded that the WCJ correctly noted in his Report that the UR decision issued within the time allowed by Labor Code section 4610(g)(I), but he then incorrectly concludes from that fact that the WCAB has no jurisdiction over the treatment dispute. Contrary to the WCJ’s conclusion, the WCAB does have jurisdiction over this dispute. Dr. Rashti requested authorization to replace the broken scooter that defendant previously provided, but the UR conducted by defendant did not address whether the broken scooter should be repaired or replaced. Instead, the UR considered whether provision of a scooter is medically supported, but that is not the issue raised by the request for authorization.
When a defendant authorizes a particular kind medical treatment it does not become obligated to provide that treatment forever. For example, the conduct of URs at reasonable intervals to address the ongoing use of a medication may be appropriate to determine if the medication continues to be effective and medically necessary. Similarly, the ongoing provision of physical therapy and chiropractic treatment may properly be evaluated through UR to determine if it is reasonable to continue to authorize those treatments. UR of other forms of medical treatment may also be supported when there is a change in the employee’s circumstances or condition that raises a question about the necessity for continued provision of the treatment. But in all of these situations, the UR that is conducted must address the treatment for which authorization is requested or the medical treatment issue in dispute. That did not occur in this case.
Here, defendant did not conduct a timely UR of the treating physician’s request for authorization to replace or repair the broken motor scooter. Thus, there is no valid UR concerning the request for authorization submitted by Dr. Rashti, and as held in Dubon II, the determination of whether the treatment should be authorized may be made by the WCAB based on substantial medical evidence consistent with Labor Code section 4604.5. Accordingly, the WCJ’s October 28, 2015 decision is rescinded and the case is returned to the trial level for consideration of the reasonableness and necessity of repairing or replacing the broken scooter.