ATHENS eBULLETIN | November 5 , 2019
Earlier this year the Workers’ Compensation Appeals Board reclassified their definition of a “working day”. With this change, along with any other changes in the California workers’ compensation system, flexibility and communication with your managed care partner is vital for a successful risk management program.
Athens Managed Care has implemented a change in the calculation of the due date of utilization review (UR) decisions to reflect the ruling made earlier this year by the Workers’ Compensation Appeals Board and their classification of a “working day”. This decision was made due to repeated litigation by applicant attorneys where workers’ compensation judges were determining that UR decisions were late because Saturday was argued to be a working day. The litigation regarding the inclusion of Saturdays as a legal working day was based on a separate court decision of Jose Gomez v. Department of Corrections. While this was not Athens’ interpretation of how the regulations were intended to be, Athens Managed Care has revised our UR timeline to include Saturday in the jurisdictional time frame.
With this Significant Panel Decision clarifying the definition of a working day, Athens Managed Care has returned to the standard utilization review time frames of:
- Prospective and Concurrent requests – within five (5) working days from the date of receipt.
- Retrospective and Appeals within thirty (30) calendar day review time.
For questions regarding changes that have been made directly relating to the Workers’ Compensation Appeals Board and the calculation of the due date of utilization review decisions please contact Leann Farlander.
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