Johnson v. JP Morgan Chase, IAB Hearing No. 1343786 (September 29, 2010)
Claimant filed a Petition to Determine Compensation Due alleging that she injured her low back and right lower extremity while working for JP Morgan Chase. Employer initially opposed the Petition. However, after a defense medical examination, it accepted compensability of injuries to Claimant's low back and right ankle. The parties continued to dispute the length of disability that resulted from the injury and payment of certain medical expenses for treatment with Dr. Bruce Grossinger based on the opinions offered by their respective medical witnesses.
Employer submitted the disputed medical expenses incurred after the date it accepted compensability to Utilization Review, but argued that the expenses incurred prior to that date should be considered under the "old" process, whereby the Board determines whether the treatment is reasonable and necessary based on testimony presented at a hearing. The Board disagreed and held that since the disputed bills were for treatment incurred after May 23, 2008 and they were related to the acknowledged injury to the lumbar spine, the bills were subject to the Utilization Review process. Employer was given 15 days from the date of the Board's Decision to submit the bills to Utilization Review or pay the bills in accordance with the applicable fee schedule.