Authorities as the decision cited them, with how this panel applied each one.
Czech v. Bank of America (2016) 81 Cal.Comp.Cases 856
Defendant's attorney has a duty to transmit a copy of the RFA to the claims administrator within a reasonable time when the attorney receives a copy of the disputed RFA after objecting that the claims administrator never received it
Applied to find defendant did not timely submit the RFA for Utilization Review
From the decision · page 3Although the strict utilization review timeframe begins upon the adjuster or UR organization's receipt of an RFA, where a dispute exists over whether an RFA was transmitted to the adjuster and defendant's attorney files an objection to the provision of medical treatment alleging that the claims administrator never received a copy of the RFA, and
State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230; Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298
Where defendant's Utilization Review decision was untimely, the injured employee is entitled to 'reasonably required' medical treatment but it is the employee's burden to establish entitlement to any particular treatment
Applied to defer determination of whether requested treatment is reasonably necessary
From the decision · page 4Code, § 4600.) Where a defendant’s Utilization Review decision was untimely, the injured employee is entitled to ‘reasonably required’ medical treatment (Lab. Code, § 4600(a)) and it is the employee’s burden to establish his or her entitlement to any particular treatment. ( State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd.
Granado v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 399; McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
To constitute substantial evidence, a physician's report must be well-reasoned, not speculative, based on an adequate history and examination, and set forth the reasoning behind the physician's opinion
Applied to find Dr. Harwood's PR-2/RFA does not constitute substantial evidence on medical necessity
From the decision · page 4(Kemp) (1981) 122 Cal.App.3th 905 [46 Cal.Comp.Cases 913].) To constitute substantial evidence, a physician’s report must be well-reasoned, not speculative, it must be based on an adequate history and examination, and it must set forth the reasoning behind the physician's opinion. ( Granado v. Workmen’s Comp. Appeals Bd.