CompFox AI Summary
Applicant Jose Lopez Franco sought reconsideration of a WCJ's decision finding that his Request for Authorization (RFA) did not qualify for expedited review and was timely decided, thus precluding WCAB jurisdiction over a medical treatment dispute. The Appeals Board granted reconsideration, finding that the evaluation of whether an RFA requires expedited review is an inherently medical determination and must be made by a medical professional within the 72-hour expedited review timeframe. As defendant's Utilization Review provider failed to do so, the Board concluded that the UR decision was untimely, vesting the WCAB with jurisdiction. The matter was rescinded and returned to the trial level for a determination of medical necessity.
Full Decision Text1 Pages
Applicant Jose Lopez Franco sought reconsideration of a WCJ's decision finding that his Request for Authorization (RFA) did not qualify for expedited review and was timely decided, thus precluding WCAB jurisdiction over a medical treatment dispute. The Appeals Board granted reconsideration, finding that the evaluation of whether an RFA requires expedited review is an inherently medical determination and must be made by a medical professional within the 72-hour expedited review timeframe. As defendant's Utilization Review provider failed to do so, the Board concluded that the UR decision was untimely, vesting the WCAB with jurisdiction. The matter was rescinded and returned to the trial level for a determination of medical necessity.
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