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question about Spinal surgery 2nd opinion process (Californi

PostPosted: Thu Mar 05, 2009 3:59 pm
by cement
Does anyone know if failure to include the treating physician on the formal spinal surgery 2nd opinion objection notice is enough to make the objection defective? Even if the treating physician was notified 2 days after the request, via the UR non certification? We sent the request to UR first, once UR denied, then we sent the spinal surgery 2nd opinion in, this all occurred within 10 days of receipt of the medical report.

Re: question about Spinal surgery 2nd opinion process (Californi

PostPosted: Sun Mar 08, 2009 2:18 pm
by jakelast@aol.com
It should not. The WCAB decision in Brasher holds that once you have denied authorization through UR, the burden shifts to Applciant do make the request for a second surgical opinion. If Applicant did not make the request because they relied upon your already having filed, there is no reason for the applicant to complain you did not do it correctly as it was their burden in the first place.

If the complaint is that you did not do it correctly, concede the point and advise applicant to file his own objection and request for a second opinion. If it is the DWC that is refusing to provide a second opinion physician, that is not really defendant's problem but is applicants.

Jake Jacobsmeyer
Shaw, Jacobsmeyer, Crain, Claffey & Nix