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No RFA Form? No Need for UR

So, here’s a puzzle for my dear, beloved readers: you receive a PR-2 in the mail, and, as part of the PR-2, there’s a request for authorization of treatment (the good doctor wants to give the injured worker a jetpack to help his self-esteem).

How many days do you have to perform UR on the request for the jetpack?

Does the clock start ticking once you realize that it’s a request for authorization?

A recent panel decision addressed this very issue:  The defense issued its UR denial on the sixth day, and applicant made the argument that it was late.  By contrast, the defense argued that without a Request for Authorization form, it was under no obligation to perform UR at all.

The WCJ, in finding for the defense, relied on California Code of Regulations section 9792.9.1(a), which holds that a request for authorization must be on the DWC RFA form.

As so properly put by the WCJ in his report, unless the RFA form is properly filled out and submitted, “no request for authorization has occurred.”

The WCJ rejected applicant’s argument that the defense waived any objection to form (or lack therefore) by performing UR, but I would be careful – other WCJs and other panels might go the other way, and reason that once the defense is aware that this is a request for authorization, it needs to perform UR.

In fact, as my dear readers will recall, the panel case in Musetti v. Golden Gate Disposal & Recycling went the other way, where the WCAB reasoned that defendant’s objection to a faulty PR-2 treatment request started the time to refer to UR.

Accordingly, it makes sense to reflect on an adopt a consistent policy of what is to be done with treatment requests not submitted on a RFA form – UR or waste bin?

The panel decision?  Torres-Ramos v. Felix Marquez; Redwood Fire & Casualty Company.

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