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New IMR Form; Requests Must Be Submitted w/ UR Decision

California Code of Regulations section 9792.10.1, subsection (b)(2).  Just an obscure regulation gathering dust, but still an interesting point to keep in mind the next time you find yourself facing some applicant-sourced resentment over a UR denial.

Subsection (b)(2) holds that if an injured worker requests independent medical review, the request must be communicated within 30 days of service of the utilization review decision, and “[t]he request must be … submitted with a copy of the written decision delaying, denying, or modifying the request for authorization of medical treatment.”

The DWC has released a bulletin, saying that reminders of this requirement will no longer be sent out, and that section (b)(2) will now begin to be enforced.

But, this cuts both ways – the UR decision denying, delaying, or modifying the decision must now come with a new form advising the injured worker of this fact.

So, what would a devious, heartless, scheming attorney recommend to his readers?  Only the obvious – do nothing.  Don’t call applicant’s counsel on day 2 of 30 and say “Ha! Ha! Ha! You didn’t submit the UR report with the IMR request!”  After all, Napoleon Bonaparte himself is said to have said “never interrupt your opponent while he is making a mistake.”

Provide the new form, and seek strict enforcement, as the applicants’ attorneys’ Bar is with Utilization Review.

Have a great weekend!

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