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How fast does utilization review have to be done after a
request for authorization?

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Whenever a Request for Authorization (RFA) is submitted by a treating physician that is not immediately authorized by the workers’ compensation carrier, it must be referred out to Utilization Review (UR) for issuance of a timely determination.  UR is a simultaneous review of a treatment recommendation by the treating physician that the carrier will either approve, modify, delay, or deny, based on medical treatment services found within Labor Code § 4600. 

Once an RFA is submitted to the workers’ compensation carrier, by facsimile or U.S. Mail, a determination must be made within 5 business days of its receipt.   If the medical treatment is approved, it must be communicated to the treating physician within 24 hours by telephone or facsimile.  Once approved requested treatment can be initiated.

If the UR decision is untimely, it may become necessary to seek enforcement through the Workers’ Compensation Appeals Board.   If found untimely the requested treatment will often be ordered, with a few exceptions.

If the treatment recommendation is denied by utilization review, the next step for the injured worker is independent medical review (IMR).

If you have any questions about your workers’ compensation case or want to talk to an attorney in Fresno, call 559-408-7436 or fill out the form to the right.