In the world of workers’ compensation, navigating the complexities of Utilization Review (UR) deferral issues can be a real headache. But fear not, because Medical Lien Management has a solution to it and can help out in it. Let’s dive into a recent case that sheds light on how to handle such scenarios like a pro.
UR deferral occurs when a defendant fails to issue a timely deferral as required by regulations. This can have significant implications for the outcome of a case, as highlighted in a recent Panel decision of the case Jose Martinez v. Hospitality Staffing Solutions.
In the Martinez case, the issue of UR deferral took center stage. Despite the defendant’s failure to issue a deferral in a timely manner (5 business days), they attempted to do so at a later stage. However, Judge Feddersen’s initial decision and subsequent report and recommendation emphasized that defendants cannot retroactively utilize UR without issuing a written decision within the specified timeframe.
If the claims administrator disputes liability for an occupational injury or recommended treatment, the medical treatment request may be deferred. The code allows for flexibility, indicating that deferral isn’t mandatory and approval is possible. However, a written decision on deferral must be issued within 5 days of receiving the request. If UR is deferred and liability is later confirmed, only then retrospective UR is applied.
The Appeals Board, led by Chair Katherine A. Zalewski, along with Marguerite Sweeney, upheld Judge Feddersen’s decision. This resulted in the entitlement of the lien for its charged amount $15,883.59, accompanied by a statutory increase of 15% and an additional 10% interest per year.
It underscores the importance of adhering to regulatory timelines when it comes to UR deferral. Failure to do so can result in significant consequences for defendants, potentially leading to adverse rulings and increased financial liabilities.
At Medical Lien Management, we pride ourselves on our expertise in handling complex workers’ compensation cases. Whether it’s navigating UR deferral issues or advocating for our clients’ rights, we are dedicated to providing top-notch legal representation and achieving favorable outcomes.
The timings really matter so you need to come up with a certain process to manage these timelines. Please contact us if you need to deal with such and we can help you out.
