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Five-day Timeframe for Issuing UR Decision Was Extended by UR Reviewer’s Timely Request for MRI Reports: Cal. Comp. Cases November Advanced Postings (11/10/2015)

November 10, 2015 (1 min read)

Here’s the latest batch of advanced postings for the November 2015 issue of Cal. Comp. Cases. and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries.

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Cynthia Crawford, Petitioner v. Workers' Compensation Appeals Board, State of California, Department of Industrial Relations, PSI, State Compensation Insurance Fund, adjusting agency, Respondents,, Lexis Advance

Medical Treatment—Utilization Review—Time Deadlines—WCAB, in split panel decision, affirmed WCJ’s finding that defendant timely issued utilization review denying majority of applicant’s treatment requests, including shoulder surgery, pursuant to 8 Cal. Code Reg. § 9792.9.1, when WCAB panel majority found that, although utilization review decisions generally must issue within five business days from date request for authorization is received, time may be extended under 8 Cal. Code Reg. § 9792.9.1(f) if claims administrator or utilization review reviewer is not in receipt of all information reasonably necessary to make determination, that in this case...

Antonia Guillen, Petitioner v. Workers' Compensation Appeals Board, Leoncio Ricarte, Jr., Lucila Ricarte, State Farm California Workers' Compensation Claims, Respondents,, Lexis Advance

Employment Relationships—Residential Employees—WCAB denied applicant’s claim for workers’ compensation benefits on grounds that applicant had not worked for homeowners for at least 52 hours in 90 calendar days before claimed date of injury, 8/16/2014, as required by Labor Code § 3352(h) for residential employees to be eligible for workers’ compensation benefits, when WCAB found that…