After MMI, the claimant sought additional treatment for his injury through his primary care physician (PCP) and was referred to an orthopedic specialist.
The orthopedic specialist recommended a fourth surgery and opined that the surgery was related to the work injury. Respondents contested the surgery as the orthopedic specialist was not authorized, and the treatment was not reasonable or necessary.
It was undisputed that the orthopedic surgeon recommending the fourth surgery was an unauthorized physician and the claimant’s request for additional medical treatment was denied and dismissed.
The claimant appealed this decision. The Industrial Claim Appeals Office affirmed the ALJ’s order and confirmed that Respondents are not liable for treatment from an unauthorized provider.
Cervantes v. Wendy’s of Colorado Springs, Inc., W.C. No. 5-106-551-006 (ICAO Dec. 17, 2025).
Want to know more? Contact Kristi Robarge at krobarge@pollartmiller.com
