Page 1 of 1

4062 procedures (California)

PostPosted: Sat May 23, 2009 8:18 am
by anonymous1
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...

Re: 4062 procedures (California)

PostPosted: Sat May 23, 2009 8:51 am
by rosellavera
See the attached case. This case might help you even though it relates to spinal surgery.

Re: 4062 procedures (California)

PostPosted: Wed May 27, 2009 7:46 pm
by jakelast@aol.com
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.