What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed and reviewed by WCAB panel after WCJ decision
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
Applicant did not fax the request for authorization to the designated fax number for utilization review, so the denial was not untimely.
From the decision · page 1As relevant here, Administrative Director Rule 9792.6.1(t)(3) provides that the request for authorization "must be signed by the treating physician and may be mailed, faxed or e-mailed to, if designated, the address, fax number, or e-mail address designated by the claims administrator for this purpose...." (Cal. Code Regs., tit. 8, § 9792.6.1(t)(3), emphasis added.) We agree with the WCJ that applicant did not fax the request for authorization (RFA) to the fax number designated by defendant for that purpose. Consequently, we also agree that defendant's utilization review (UR) denial was not untimely.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.