Diaz, Frank

Applicant Frank Diaz, a construction worker injured on April 16, 2020, sought reconsideration of a WCJ's Findings and Order holding that an August 31, 2022 Utilization Review (UR) of his treating physician's Request for Authorization (RFA) was timely. Dr. Miller's RFA included a 30-day inpatient request at Casa Colina that he labeled an 'expedited request,' which UR non-certified, while certifying the other requested treatments. Applicant argued the RFA required expedited 72-hour review under AD Rule 9792.9.1(c)(4) and that the UR was therefore untimely, entitling him to the treatment. The Board found that none of Dr. Miller's reports documented an imminent and serious threat to applicant's health that would warrant expedited review, so the request was properly subject to the five-business-day timeframe under subdivision (c)(3) and the UR was timely. Because the UR was timely, the Appeals Board lacked jurisdiction to determine medical necessity, and reconsideration was denied.