Bodam: A UR Not Communicated Timely Is A UR Not Timely At All

On October 3rd, 2017

The WCAB has issued an opinion supplementing the Court's prior opinion in Dubon, that a Utilization Review (UR) decision to deny medical treatment must be communicated to the required parties (ie. treating physician, injured worker etc.) within the required time frame or it will be deemed untimely. Bodam v. San Bernardino County (2014) 79 Cal. Comp. Cases 1519.

This means that if an insurer timely completes a UR denial for the treatment requested by an injured worker's treating physician, it still must be communicated to the physician and injured worker within the required timeframes. If the UR is not timely, then the UR is invalid pursuant to Dubon and the injured worker may pursue an order from the WCAB that the treatment be authorized.

It should be noted that this opinion has been designated as a significant panel decision. Therefore, even though it is not binding on lower courts, it is does provide a strong indication as to how the WCAB will decide this particular issue.

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