www.howserlaw.com (213)377-5513
In California Worker’s Compensation, when a primary treating doctor has requested treatment from the insurance company, he or she must do so on a very specific form called a request for authorization or RFA form.
Until that RFA form is submitted to the insurance carrier, the insurance company will not need to act on a treatment request. It is important that the doctor issue that request on that form so that we will know when a authorization or denial is due.
I have had clients that told me that the doctors office informed them their treatment was denied and then when I became the attorney of record on the case I asked for the request for authorization that was submitted to the insurance, only to find out that it had never been done.
California law requires that an insurance carrier act on a request for authorization within five business days or seven days total. If the insurance carrier has not authorized or denied the request to treatment within those seven days, any denials later issued are untimely or invalid in the eyes of the law. If the doctor has submitted the request for authorization with sufficient evidence to support the request, a judge can order that the treatment be authorized.
If the insurance company denies a treatment request and the denial is made on time, and injured worker must submit a request for independent medical review. This is the injured workers only opportunity in essence to appeal a treatment denial. If that denial is not a peeled, or it is a peeled and upheld by independent medical review, the denial will be in place for 12 months.
If you have received a copy of an Application for Independent Medical Review form that looks like this it’s important that you take action now. If you have questions about your Worker’s Compensation case or like a consultation, please call or text my office at (213)377-5513, and will be happy to give you an evaluation completely free.
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