4062 procedures (California)

This category is meant for discussion of technical legal issues in workers' compensation. If you are an injured worker, do not ask questions here. Go to the Injured Workers' forum.

4062 procedures (California)

Postby anonymous1 on Sat May 23, 2009 8:18 am

Would you agree that it is clear, based on the plain language of 4062 and the holdings in Willette and Sandhagen, that following a timely UR denial an employee must timely object and obtain a Panel QME regarding a treatment dispute and that any hearing set regarding the treatment dispute would be premature until the parties go through the Panel QME process?

But what would be the remedy if there is NOT a timely objection to a UR denial but a hearing is requested and set regarding the disputed treatment? Would you agree that if there is no timely objection to a UR denial that the issue is done and that the employee has no recourse at that time?

Your thoughts would be appreciated...
Posts: 1
Joined: Sat May 23, 2009 8:11 am

Re: 4062 procedures (California)

Postby rosellavera on Sat May 23, 2009 8:51 am

See the attached case. This case might help you even though it relates to spinal surgery.
Brashner v SCIF.rtf
(67.09 KiB) Downloaded 238 times
User avatar
Posts: 440
Joined: Wed Mar 04, 2009 7:52 pm

Re: 4062 procedures (California)

Postby jakelast@aol.com on Wed May 27, 2009 7:46 pm

I think your assessment is correct. LC 4610 and 4062 mandate that applicant object and utilize the 4062 process to challange a timely UR. I have this issue come up occassionally at the wcab an uniformly WCJ's will agree, sometimes reluctantly, that the applicant is not entitled to an expedited hearing without completing the 4062 process. In general I have not pushed the issue of finality of the UR determination but have negotiated on the merits of the issue.
Jake Jacobsmeyer
Shaw, Jacobsmeyer, Crain & Claffey
User avatar
Posts: 89
Joined: Sun Mar 08, 2009 2:12 pm

Return to Legal

Who is online

Users browsing this forum: No registered users and 2 guests