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Does the employer need to respond to an RFA from the secondary treating physician or just the PTP?

Does the employer need to respond to an RFA from the secondary treating physician or just the PTP?

Injured workers often elect both a primary treating physician (PTP) and a secondary treating physician. Both doctors may request specific treatment, and the question arises: Does the employer need to respond to an RFA from the secondary treating physician or just the PTP?

The answer is both. The requirement is that the form RFA must be “completed by a treating physician,” and this is not limited to only the PTP. In the case of Lopez v. City and County of San Francisco (2016), the WCAB panel reasoned that there is no express requirement in the Labor Code or the Administrative Director Rules that an RFA may only be submitted by a primary treating physician (PTP). The appeals board held that requests for authorization from a secondary treating physician also trigger the utilization review process.

The fact that UR/IMR still applies is good news for defendants who want to assure medical treatment stays on course and remains “reasonable and necessary.” However, the UR/IMR process must still abide by the rules and timelines developed by case law (e.g., proper service on all parties and 5-day rule) or the WCAB may invoke jurisdiction to make a medical determination.

If you have questions about the very intricate rules and regulations regarding UR/IMR, or whether a UR/IMR decision can be upheld, reach out to your local RTGR office.

 

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