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Expedited Review of Requests for Treatment

An employer must conduct utilization review (UR) to determine whether to approve, modify or deny a request for treatment. If the medical services have not been provided, Labor Code 4610(i)(1) normally requires the UR determination to be made within "five normal business days from the receipt of a request for authorization for medical treatment and supporting information reasonably necessary to make the determination, but in no event more than 14 days from the date of the medical treatment recommendation by the physician." California Code of Regulations § 9792.9.1(c)(3) generally requires prospective or concurrent UR decisions to be made within five business days from the date of receipt of the completed DWC form RFA (request for authorization).

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Requesting Consulting Physicians Within an MPN

Labor Code 4616.3(c) establishes a process that allows injured employees to obtain second and third opinions from physicians within a medical provider network. It states, "If an injured employee disputes either the diagnosis or the treatment prescribed by the treating physician, the employee may seek the opinion of another physician in the medical provider network. If the injured employee disputes the diagnosis or treatment prescribed by the second physician, the employee may seek the opinion of a third physician in the medical provider network." Per LC 4616.4(b), "If, after the third physician's opinion, the treatment or diagnostic service remains disputed, the injured employee may request an MPN independent medical review regarding the disputed treatment or diagnostic service still in dispute ... in accordance with Section 4616.3." That's referred to as an MPN IMR. California Code of Regulations § 9767.7 supports those statutes. CCR 9767.7(a) restates that an employee may obtain a...

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Applied Materials v. WCAB: 6th District Court of Appeal Holds That Physician Misconduct Is Compensable, But Upholds Fitzpatrick

On June 1, 2021, the 6th District Court of Appeal certified for publication its decision in Applied Materials et al. v. WCAB. The decision can be reviewed on the California courts' website. In that case, the Court of Appeal issued a lengthy, 73-page decision addressing multiple issues raised by the parties. The decision is most significant for two issues:

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