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New Regs on Request for Treatment Authorization

December 17th, 2012

Happy Monday, dear readers!  The Holidays are upon us!  Channukah (Hag Sameach to my Jewish readers!) came to a close over the weekend, and Christmas is just around the corner (Feliz Navidad!)

Always eager to please, your humble blogger has prepared this post to get you into the festive spirit with a lump of coal for all the naughty lien claimants in California’s workers’ compensation system.  Now, granted, in certain parts of the world, a lump of coal is a wonderful gift that will literally keep the family warm on Christmas, but in California, coal isn’t going to help pay for any lien claimant’s vacation home or golden back-scratchers.

What is this lump of coal?

Well, often enough, lien claimants complain and complain about unpaid “medical” bills even though the treating physician had prescribed there much-needed “chanting therapy” or “television-based rehabilitation.”

Well, California Code of Regulations section 97292.6, subsection (o), specifically lays out what the treating physician needs to do in order to request authorization for treatment.  That includes filling out the PR-2 form or a narrative report containing all the information on the PR-2 form with a “request for treatment” across the top of the first page.

Well, no more!  For injuries occurring after January 1, 2013, or requests for treatment made after July 1, 2013, any request for authorization will have to be made on the section 9785.5 Request for Authorization form.  Assuming the proposed regulations are approved, narrative reports will no longer be sufficient – the form will have to be used.  And, if the form is not used and filled out with all “mandatory fields” (proposed regulation section 9792.6.1(o)), the defense will not have an actual request for authorization of treatment.

Another interesting aspect of these proposed regulations is that, just over fifty years after the first e-mail was sent, the regulations now recognize that e-mail is an appropriate way of communicating information.  Reports and requests for authorization can now be transmitted by mail, facsimile, or e-mail (carrier pigeon ended up on the chopping block).

This is actually a negative for most of us on the defense side – your typical adjuster is overworked and swamped with letters, faxes, and e-mails… this may make it possible for more treatment requests to fall through the cracks.

There are more proposed regulations, dear readers, and more on the way, but hopefully we’ll have a grip on these “reforms” before too long!


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