WCAB Significant Decision
Timothy Bodam v. San Bernardino County/ Department of Social Services legally uninsured (Nov. 20, 2014)
- Case No. ADJ8120989 (SBR 0041910)
- 79 Cal. Comp. Cases 1519
In affirming the Workers’ Compensation Judge’s finding that defendant’s Utilization Review (UR) decision was not timely communicated to the requesting physician and the employee as required by Labor Code section 4610(g)(3)(A) and Administrative Director’s Rule 9792.9.1(e)(3), the Appeals Board held: (1) A defendant is obligated to comply with all time requirements in conducting a UR, including the timeframes for communicating the UR decision; (2) A UR decision that is timely made but is not timely communicated is untimely; (3) When a UR decision is untimely and, therefore, invalid, the necessity of the medical treatment at issue may be determined by the WCAB based upon substantial evidence.
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