CompFox AI Summary
In this Workers' Compensation Appeals Board case, applicant Glory Shreeve sought authorization for medical treatment, which was denied by the defendant's Utilization Review (UR) provider. Applicant argued the UR denials were untimely because requests for additional information were not made by a licensed physician, thus invalidating the delays and granting the Board jurisdiction over medical necessity. The Board affirmed the Administrative Law Judge's decision, finding that the UR provider's requests for additional information did not violate Labor Code Section 4610(e) and that the denials were issued within the extended timeframes permitted by DWC Rule 9792.9.1. Consequently, the Board held it lacked jurisdiction to determine the reasonableness and necessity of the requested medical treatment due to the timely UR denials.
Full Decision Text1 Pages
In this Workers' Compensation Appeals Board case, applicant Glory Shreeve sought authorization for medical treatment, which was denied by the defendant's Utilization Review (UR) provider. Applicant argued the UR denials were untimely because requests for additional information were not made by a licensed physician, thus invalidating the delays and granting the Board jurisdiction over medical necessity. The Board affirmed the Administrative Law Judge's decision, finding that the UR provider's requests for additional information did not violate Labor Code Section 4610(e) and that the denials were issued within the extended timeframes permitted by DWC Rule 9792.9.1. Consequently, the Board held it lacked jurisdiction to determine the reasonableness and necessity of the requested medical treatment due to the timely UR denials.
Read the full decision
Join + legal professionals. Create a free account to access the complete text of this decision and search our entire database.