CompFox AI Summary
The Appeals Board vacated the original award, finding the record insufficient to determine if the applicant's ongoing medication use qualified for prior authorization without new utilization review (UR), as per Patterson. The Board also corrected the WCJ's UR timeliness calculation, finding the determination likely timely under the proper Administrative Director Rule. However, the case is remanded to develop the record on whether UR was required and if the UR decision was communicated timely, before addressing penalties. The issue of penalties and attorney fees is deferred pending these further proceedings.
Full Decision Text1 Pages
The Appeals Board vacated the original award, finding the record insufficient to determine if the applicant's ongoing medication use qualified for prior authorization without new utilization review (UR), as per Patterson. The Board also corrected the WCJ's UR timeliness calculation, finding the determination likely timely under the proper Administrative Director Rule. However, the case is remanded to develop the record on whether UR was required and if the UR decision was communicated timely, before addressing penalties. The issue of penalties and attorney fees is deferred pending these further proceedings.
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