California: Utilization Review Not Defective When Request for Additional Information Necessary to Make UR Determination Signed by Non-Physician

In a noteworthy panel decision issued August 21, 2014, the WCAB in Newton v. Jack-In-The-Box, 2014 Cal. Wrk. Comp. P.D. LEXIS – , rescinded the WCJ’s award of medical treatment in the form of aquatic therapy after the defendant objected to the WCAB’s 7/7/2014 Notice of Intention to Award Medical Treatment [see Newton v. Jack-In-The-Box, 2014 Cal. Wrk. Comp. P.D. LEXIS 356 (Lexis Advance), 2014 Cal. Wrk. Comp. P.D. LEXIS 356 (lexis.com)], which was based upon the WCAB’s finding that the defendant’s 8/11/2013 utilization review (UR) decision was materially defective pursuant to Labor Code § 4610(e) because it was signed by a registered nurse rather than a physician.

The defendant objected to the WCAB’s finding of defective UR on the basis that the 8/11/2013 UR was not a determination to delay a request for authorization requiring a physician’s signature as the WCAB had concluded, but was rather a request for additional information from the applicant’s treating physician necessary to determine whether to approve, modify, delay, or deny the request for authorization.

The WCAB accepted the defendant’s explanation, noting that requests for additional information necessary to make a UR determination can be made and signed by a non-physician under Labor Code § 4610(d) and 8 Cal. Code Reg. § 9792.9.1(f).

Read the Newton noteworthy panel decision issued August 21, 2014.

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