What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed and denied by the Appeals Board panel
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.
Medical treatment / UR / IMRDefendant prevailedlumbar spine
Applicant failed to identify any medical report or record reviewed by IMR that would support the argument that the IMR determination was based on a plainly erroneous finding of fact. The June 2, 2025 report by PTP Dr. Hannani was not reviewed by IMR and did not specify any new diagnostic evidence. The difference of opinion between IMR and PTP reports requires expert opinion and is not a matter of ordinary knowledge.
From the decision · page 94. Petitioner contends that the court erred by finding that: a. The Independent Medical Review (IMR) determination dated July 22, 2025 was NOT based on a plainly erroneous express or implied finding of fact requiring reversal. b. The June 2, 2025 report from PTP Dr. Kambiz Hannani failed to identify a material change in circumstances requiring a new utilization review following the May 20, 2025 utilization review denial. FACTS