The decision became binding on all DWC administrative law judges on Dec. 14, 2009. Based on Cervantes, a claims administrator who receives a valid request for authorization for spinal surgery has 10 calendar days to complete the utilization review process and if the surgery is not authorized as requested, to file the DWC form 233, Objection to Treating Physician's Recommendation for Spinal Surgery. The 10-calendar day time limit begins to run upon receipt of a valid request for authorization. A claims administrator who fails to complete the utilization review within the 10-day limit will be required to authorize the requested spinal surgery. DWC 233 forms served before Dec. 14, 2009, will be processed as explained in Labor Code Section 4062(b) and 8 Cal. Code Regs. Sections 9788.1 - 9788.91 under the pre-Cervantes rules. Effective Dec. 25, 2009, the DWC Medical Unit will reject requests for spinal surgery second-opinion evaluations that are incomplete, that fail to provide evidence of completion of utilization review within 10 calendar days of the receipt of a valid request for authorization, or that fail to provide a full copy of the requesting treating physician's report with the DWC form 233. For more information, visit http://dir.ca.gov.
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February 18, 2010
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