CompFox AI Summary
This Workers' Compensation Appeals Board decision affirms a prior finding that the defendant's utilization review (UR) was untimely. The Board found that even if the defendant received the request for treatment authorization on July 8, 2013, their subsequent UR denial dated July 15, 2013, was still untimely. The critical factor was the defendant's failure to provide initial communication of the denial via telephone, facsimile, or electronic mail, as required by Labor Code section 4610 and Administrative Director Rule 9792.9.1. Consequently, independent medical review was not appropriate, and the applicant's need for further medical treatment was upheld.
Full Decision Text1 Pages
This Workers' Compensation Appeals Board decision affirms a prior finding that the defendant's utilization review (UR) was untimely. The Board found that even if the defendant received the request for treatment authorization on July 8, 2013, their subsequent UR denial dated July 15, 2013, was still untimely. The critical factor was the defendant's failure to provide initial communication of the denial via telephone, facsimile, or electronic mail, as required by Labor Code section 4610 and Administrative Director Rule 9792.9.1. Consequently, independent medical review was not appropriate, and the applicant's need for further medical treatment was upheld.
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