And here we are again, dear readers – Monday morning roulette.  Will there be good news?  Will there be bad new?  Will your humble blogger frantically call you asking to post his bail?

Relax, dear readers, it’s one of those “good news” blog posts. 

The WCAB came down recently on the side of defendant in the case of Batson v. CA Department of Corrections.  Applicant alleged an injury and during the course of its investigation, Utilization Review certified the need for hydrocodone-acetaminophen, left hip total replacement surgery, and intermittent limb compression DVT and venaflow calf cuffs.  In other words, it looked like defendant might be exposed to more than just some Advil and an x-ray while it explored if the claim was compensable, and might actually reach the $10,000 cap of Labor Code section 4502(c). 

However, between the date UR certified the treatment and the treatment was actually to be provided, defendant denied the claim.

Applicant went to trial on this issue, seeking to require provision of treatment “authorized” by Utilization Review prior to the issuance of the denial.  The WCJ ruled that the treatment must be provided by defendant, and defendant sought the intervention of the commissioners of the WCAB.

In reversing the WCJ, the WCAB noted that utilization review is limited in scope to medical necessity.  Accordingly, a treatment might be entirely reasonable and medically necessary, but this does not address the question of whether the claim is compensable or whether the need for the treatment is industrial in cause.

Further, the WCAB held “[r]egardless of whether treatment is medically necessary, by the plain language of section 5402(c), a defendant is not required to provide medical treatment after it has timely rejected liability.”

Now, the kids these days are finishing their online communications with “tl;dr” which I am informed by credible sources means “too long; didn’t read.”  In the spirit of embracing the new, allow your humble blogger to offer this tl;dr – Certification of medical necessity is rendered irrelevant by the issuance of a timely denial.

Have a good week, dear readers!