CompFox AI Summary
In this workers' compensation case, the applicant sought home health care following industrial injuries. The defendant denied authorization via Utilization Review (UR), and the applicant subsequently filed for Independent Medical Review (IMR). The Appeals Board granted the applicant's petition for removal, rescinding the prior order that sent the matter off calendar for IMR. The Board clarified that challenges to the timeliness and procedural validity of UR denials fall under the WCAB's jurisdiction, not IMR. The case is returned to the trial level for an expedited hearing on the validity of the UR decision, with IMR only to proceed if the UR is deemed timely and valid.
Full Decision Text1 Pages
In this workers' compensation case, the applicant sought home health care following industrial injuries. The defendant denied authorization via Utilization Review (UR), and the applicant subsequently filed for Independent Medical Review (IMR). The Appeals Board granted the applicant's petition for removal, rescinding the prior order that sent the matter off calendar for IMR. The Board clarified that challenges to the timeliness and procedural validity of UR denials fall under the WCAB's jurisdiction, not IMR. The case is returned to the trial level for an expedited hearing on the validity of the UR decision, with IMR only to proceed if the UR is deemed timely and valid.
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