CompFox AI Summary
This case concerns the defendant's failure to conduct timely Utilization Review (UR) on an April 2016 Request For Authorization (RFA) for the medication Enbrel. The Board denied the defendant's petition for reconsideration, upholding the WCJ's finding that the defendant's prior, invalid UR attempt in November 2015 did not relieve them of their obligation. Because no timely UR was performed on the valid RFA, the WCAB has authority to determine the medical necessity of Enbrel. The WCJ's award of Enbrel is supported by substantial evidence.
Full Decision Text1 Pages
This case concerns the defendant's failure to conduct timely Utilization Review (UR) on an April 2016 Request For Authorization (RFA) for the medication Enbrel. The Board denied the defendant's petition for reconsideration, upholding the WCJ's finding that the defendant's prior, invalid UR attempt in November 2015 did not relieve them of their obligation. Because no timely UR was performed on the valid RFA, the WCAB has authority to determine the medical necessity of Enbrel. The WCJ's award of Enbrel is supported by substantial evidence.
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