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Receipt of a Request for Authorization by a Defense Attorney

Posted by Sure S. Log on Sep 21, 2022 3:00:00 PM

Labor Code § 4600(g)(2)(A) states, "Unless otherwise indicated in this section, a physician providing treatment under Section 4600 shall send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to rules adopted by the administrative director." The statute directs that a request for authorization for medical treatment (RFA) must be sent to a claims administrator, rather than somewhere else, although the claims administrator may designate where the RFA is sent (CCR 9792.6.1(t)(3)).

That language was added effective Jan. 1, 2017, by AB 2503. Pursuant to the Senate Floor Analysis, "[I]t is often difficult for health care providers in the workers' compensation system to obtain timely approval for treatment of injured workers because it is difficult to know where to send RFAs." So, the bill was "intended to clarify where the RFA and related materials must be sent, so that the time frames specified in statute will be more effective." Pursuant to the Assembly Floor Analysis, "AB 2503 requires that a RFA is submitted directly to a claims administrator, rather than a UR vendor or some other third party."

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Topics: Utilization Review, RFA, defense