CompFox AI Summary
This case involves an applicant seeking reconsideration of a denied Request for Authorization (RFA) for knee surgery due to alleged defective utilization review (UR) communication. The applicant argued the UR denial was untimely because it wasn't served on his attorney within the required two business days. However, the Board affirmed the WCJ's decision, finding the UR determination was timely communicated. The Board reasoned that the rule requires service within two business days, not actual receipt, and inferred timely mailing given the attorney's eventual acknowledgment. Consequently, the petition for reconsideration was denied.
Full Decision Text1 Pages
This case involves an applicant seeking reconsideration of a denied Request for Authorization (RFA) for knee surgery due to alleged defective utilization review (UR) communication. The applicant argued the UR denial was untimely because it wasn't served on his attorney within the required two business days. However, the Board affirmed the WCJ's decision, finding the UR determination was timely communicated. The Board reasoned that the rule requires service within two business days, not actual receipt, and inferred timely mailing given the attorney's eventual acknowledgment. Consequently, the petition for reconsideration was denied.
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