Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 9792.9.1(c)(4)
Request for Authorization (RFA) must be reviewed by a medical professional within 72 hours for expedited review under AD Rule 9792.9.1(c)(4).
The Board found the RFA was not reviewed by a medical professional within the required timeframe, thus jurisdiction was proper.
From the decision · page 6fax of the RFA indicated it was sent at 3:39 p.m. (Exhibit X.) Thus, it is deemed received on July 31,
2025. (Cal. Code Regs., tit. 8 § 9792.9.1(a)(1), amended effective 04/01/2026.) The determination
indicates that the vendor did receive the RFA within the 72 hour timeframe, but there is no indication
of when it was reviewed, but the decision date is August 6, 2025, well beyond 72 hours. Moreover,
there is no notation in the determination as to the reasons the request did not qualify for expedited
review, by the medical professional. While the request is for a program beginning after the typical five
day timeframe for decisions pursuant to former AD Rule 9792.9.1 (c)(3), the request still had to be
reviewed by a medical professional to determine whether the typical timeframe is not warranted.
Moreover, the language in former AD Rule 9792.9.1(c) is disjunctive. Even if the analysis does not
satisfy one condition, here the standard timeline component, the rule still requires determining whether
there is an imminent threat to the health of the patient. The evidence in the record is not clear that the
RFA was reviewed by a medical professional within 72 hours for either reason. If it is untimely, the
WCAB is vested with jurisdiction over the underlying medical treatment dispute. (Dubon v. World
Restoration (2014) 79 Cal.Comp.Cases 1298 [2014 Cal. Wrk. Comp. LEXIS 131].)
Labor Code section 4610.5
Labor Code section 4610.5 governs expedited review of medical treatment requests.
The Board applied this statute to determine the timeliness and jurisdiction of the expedited review.
From the decision · page 1Applicant contends that defendant did not meet their burden of proof that they complied with
the timeframes required for expedited review of an RFA pursuant to Labor Code section 4610.5.0F1
Applicant also contends that there was not a change of circumstance warranting the RFA for
recertification and that not providing a safe discharge plan is contrary to the Labor Code.
Lab. Code, 5803
The Appeals Board has continuing jurisdiction to rescind, alter, or amend any order, decision, or award for good cause.
The Board exercised continuing jurisdiction to grant reconsideration and remand for further proceedings.
From the decision · page 7(1958) 50 Cal.2d 360, 364.) ["[t]here is no provision in chapter 7, dealing with proceedings
for reconsideration and judicial review, limiting the time within which the commission may make its
decision on reconsideration, and in the absence of a statutory authority limitation none will be
implied."]; see generally Lab. Code, § 5803 ["The appeals board has continuing jurisdiction over all
its orders, decisions, and awards.... At any time, upon notice and after an opportunity to be heard is
given to the parties in interest, the appeals board may rescind, alter, or amend any order, decision, or
award, good cause appearing therefor."].) A decision "must be based on admitted evidence in the
record" (Hamilton, supra, at p. 478), and must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases
310]; Garza v. Workmen's Comp. Appeals Bd.