Home > Uncategorized > WCAB: UR Decision Com. To PTP’s Office; Not Nec. PTP

WCAB: UR Decision Com. To PTP’s Office; Not Nec. PTP

Your humble blogger has long been an advocate of improving service and communication among the various players in our little workers’ compensation game.  To that effect, I’ve encouraged various legislative organizations and even the Governor to recognize, like in days of old, the elegance and efficiency of using carrier pigeons to communicate.  For whatever reasons, my phone calls (and carrier pigeons) have not been returned.

The thing is, that we’re no longer operating in small, one-person shops.  Doctors aren’t processing paperwork and installing anti-virus software themselves – there’s support staff: assistants, secretaries, etc.  Apparently, doctors aren’t even managing their own carrier pigeon coop.  Some day, dear readers… some day…

So, when the modern regulations or statutes refer to service on or a communication with a physician, is it enough to communicate a document to the physician’s office, or must the document be hand-delivered to the physician him or herself?

In the case of Gutierrez v. Bigge Crane & Rigging Co., applicant’s primary treating physician requested authorization for some prescription medication.  However, although UR recommended that authorization for the treatment be denied, the WCJ found that the UR decision was not timely communicated to the PTP, and the UR was deemed invalid.  The WCJ then determined that the treatment was reasonable and necessary and ordered it to be provided to the applicant.

The record apparently does not include any proof that the UR determination was communicated to the PTP within 24 hours, as required by section 9792.9.1(e)(3), but only has a letter documenting a conversation between the UR physician and the PTP’s assistant (or possibly the PTP as well).

In affirming the WCJ, the WCAB held that a defendant meets its burden by communicating the decision to the PTP’s office, rather than solely by communicating it to the PTP him or herself.  However, in this case, there was not enough documentation in the record to support such communication.

In your humble blogger’s practice, sometimes I have observed applicants raising the argument that, although a document reflects that it was faxed to  a PTP, there’s no proof that it actually was (especially when the PTP’s office has little to no incentive to produce a timely facsimile log).  Which is why, yet again, your humble blogger is pushing the carrier pigeon idea: the pigeon will be ready to testify under oath…

Perhaps UR vendors should include fax confirmation reports with their UR transmissions to the employer, insurer, and defense attorneys?  Or, better yet, perhaps the Department of Industrial Relations can apply its vast and endless influence to require all physicians who wish to treat industrial injuries to register and maintain a valid e-mail address as a means of receiving communication and UR notices.

But, then again, perhaps some people don’t want an easy-to-use and easy-to-verify system of communication.  After all, the harder you make it for UR to communicate the decision to the PTP, and the harder you make it for the defendant to prove that UR communicated the decision to the PTP, doesn’t it get easier for the PTP do perform the treatment he requested?

In any case, as per the Guttierez decision UR determinations must be communicated to the requesting physician’s office rather than the physician.  What are your thoughts?  I’ll be looking for your pigeons on the horizon with your comments…

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