CompFox AI Summary
The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior decision that approved medical treatment. The Board found that the defendant timely denied the applicant's claim of industrial injury within the 90-day window allowed by Labor Code section 5402(c). Therefore, the defendant is not obligated to provide the disputed medical treatment, as liability for treatment under this section is limited until acceptance or rejection of the claim. The Court clarified that utilization review's medical necessity certification does not override a timely denial of the claim itself.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior decision that approved medical treatment. The Board found that the defendant timely denied the applicant's claim of industrial injury within the 90-day window allowed by Labor Code section 5402(c). Therefore, the defendant is not obligated to provide the disputed medical treatment, as liability for treatment under this section is limited until acceptance or rejection of the claim. The Court clarified that utilization review's medical necessity certification does not override a timely denial of the claim itself.
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