CompFox AI Summary
This case concerns the timeliness of a Utilization Review (UR) denial for requested medical treatment. The applicant argued the UR denial was untimely because it was issued on the 15th calendar day, exceeding the 14-day statutory limit under Labor Code section 4610(i)(1). The Appeals Board granted reconsideration, rescinding the prior decision that found the UR timely. The Board determined the UR denial was indeed untimely and remanded the case for a new decision on the medical necessity of the treatment.
Full Decision Text1 Pages
This case concerns the timeliness of a Utilization Review (UR) denial for requested medical treatment. The applicant argued the UR denial was untimely because it was issued on the 15th calendar day, exceeding the 14-day statutory limit under Labor Code section 4610(i)(1). The Appeals Board granted reconsideration, rescinding the prior decision that found the UR timely. The Board determined the UR denial was indeed untimely and remanded the case for a new decision on the medical necessity of the treatment.
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