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Defense object to UR? (California)

PostPosted: Wed Jul 10, 2013 10:18 am
by compquest
SCENARIO:

1. UR approves a spine surgery on 7/1/13.

2. The defense wants to get UR to reconsider the decision. I see the Applicant Doctors do it all the time, but not the adjuster or defense attorney.

QUESTION:

1. Can the defense request a reconsideration / Appeal of UR decision?

2. Alternativelly can the defense send it to IMR?
Seems not because the surgery was authorized.

Re: Defense object to UR? (California)

PostPosted: Wed Jul 10, 2013 3:03 pm
by injured7825
Why would you want to appeal a UR decision, 2 doctors say this person needed back surgery, one of those doctors being the insurer's doctor, is it possible the adjuster or the defense knows better than a doctor when it comes to medical decision?