CompFox AI Summary
This case concerns the timeliness of a defendant's utilization review (UR) denial for requested medical treatment. The Workers' Compensation Appeals Board (WCAB) rescinded the initial decision awarding treatment, finding the defendant's UR denial was timely made and served within the five-business-day window. The key issue was whether a UR denial sent via facsimile after 5:30 p.m. on the fifth business day was valid. The Board concluded the UR decision was timely made and communicated within 24 hours of its making, rendering it valid and requiring disputes to go through the Independent Medical Review (IMR) process.
Full Decision Text1 Pages
This case concerns the timeliness of a defendant's utilization review (UR) denial for requested medical treatment. The Workers' Compensation Appeals Board (WCAB) rescinded the initial decision awarding treatment, finding the defendant's UR denial was timely made and served within the five-business-day window. The key issue was whether a UR denial sent via facsimile after 5:30 p.m. on the fifth business day was valid. The Board concluded the UR decision was timely made and communicated within 24 hours of its making, rendering it valid and requiring disputes to go through the Independent Medical Review (IMR) process.
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