Skip to main content Sullivan on Comp icon

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."

Read More

Topics: Utilization Review, RFA, defense

Designating Address, Fax Number or Email Address for Utilization Review Purposes

Posted by Sure S. Log on Mar 16, 2022 12:45:00 PM

Effective Jan. 1, 2022, the Workers' Compensation Appeals Board (WCAB) amended its Rules of Practice and Procedure to permit electronic service, including via email. The Labor Code, however, previously recognized electronic service of a request for authorization (RFA) for medical treatment. Specifically, LC 4610(i)(1) states: "The request for authorization and supporting documentation may be submitted electronically under rules adopted by the administrative director."

To avoid complications and unnecessary delays in the utilization review (UR) process, the Labor Code and administrative regulations also specify to whom and how RFAs must be served. LC 4610(g)(2)(A) requires a requesting physician to send an RFA "to the claims administrator for the employer, insurer, or other entity according to the rules adopted by the administrative director." That language was adopted because physicians expressed difficulty in determining to whom an RFA should be sent. So the Labor Code clarifies that the RFA and related materials should be sent to the claims administrator.

Read More

Topics: Division of Workers' Compensation, Workers' Compensation Appeals Board, Utilization Review, Request for Authorization, Service

Subscribe Here!

Recent Posts

Posts by Tag

See all