CA: Dispute Resolution Process Must Be Used to Object to Timely Utilization Review Denials

Tomas Garcia v. Meterman, Inc.

Medical Treatment—Utilization Review—WCAB rescinded WCJ's finding issued after expedited hearing that applicant/foreman/laborer was entitled to an orthopedic mattress as part of his medical treatment to cure or relieve effects of his 10/1/2004 admitted industrial injuries to back, legs and psyche, when defendant timely denied utilization review (UR) authorization for orthopedic mattress on multiple occasions but applicant failed to effectively object to utilization review denials by initiating process to dispute denial of treatment as set forth in Labor Code § 4062, and WCAB, finding that had applicant timely objected to UR denial she would have been re-evaluated by agreed medical evaluator (AME), remanded matter for referral of parties back to AME to resolve dispute. © Copyright 2010 LexisNexis. All rights reserved.

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Source: Calif. Workers’ Compensation Appeals Board