Opinion ID: 2335487
Heading Depth: 2
Heading Rank: 1

Heading: March 31, 2001 Compensation Order

Text: Petitioner argues that ALJ Carney erred in denying reimbursement for several causally related medical expenses. Her brief, however, refers to only one medical expense  megavitamin infusions  for which she was denied reimbursement and to which she argues she is entitled. To the extent petitioner claims that the Director erred in affirming the ALJ's denial of other medical expenses, we consider the claims abandoned. See D.C.App. R. 28(a)(8)(A) (briefs must contain contentions and the reasons for them, with citations to the authorities and parts of the record on which the [petitioner] relies). With respect to the megavitamin infusions, petitioner claims that the ALJ failed to give great weight to her physician's recommendation that she be treated with megavitamin infusions. [9] In this case, however, a utilization review performed by an independent expert, Dr. Joshua T. Yurfest, concluded that the megavitamin infusions were not necessary. His report noted that use of megavitamins, folate and magnesium via IV administration has not been supported by the literature and has not been proven to be of value to the management of fibromyalgia. Under the Workers' Compensation Act, [w]hen it appears that the necessity, character, or sufficiency of medical care or service to an employee is improper or that medical care or service scheduled to be furnished must be clarified, the Mayor, employee, or employer may initiate review by a utilization review organization or individual. D.C.Code § 32-1507(b)(6)(B). Petitioner was entitled to submit any evidence to the utilization review team, but once the utilization review is completed, as the ALJ noted, the report . . . is decisive on the issue of reasonableness and necessity of medical services unless specific reasons are articulated why it should not be decisive. See Sibley Mem'l Hosp. v. D.C. Dep't of Employment Servs., 711 A.2d 105, 107 (D.C.1998) (referring to purpose of statutory provision for utilization review as contain[ment of] medical costs without diminishing the quality of health care. Hence, a utilization review report presented to DOES that concludes the [treatment] performed was unreasonable requires DOES to address specifically this report and articulate reasons why this report is being rejected. (citing D.C.Code § 32-1507(b)(6) (2001))). The ALJ properly relied on the conclusion of the utilization review, which was supported by employer's medical expert, despite the contrary opinions of petitioner's physicians, who recommended megavitamin infusions. Accordingly, we conclude that the Director's decision affirming the ALJ's denial of reimbursement for megavitamin infusions was according to law and supported by substantial evidence.