Timothy Bodam

Applicant Timothy Bodam sustained an industrial injury to his lower back on March 24, 2011. His treating physician Dr. Cheng submitted an RFA for three-level spinal fusion surgery on October 28, 2013, which the defendant referred to UR. The UR decision to deny was timely made on October 31, 2013, but was not communicated to the requesting physician within 24 hours by phone/fax/email, and written notice was not sent until November 5, 2013 (beyond two business days). The WCJ found the UR untimely and therefore invalid, giving the WCAB jurisdiction to determine medical necessity, and ordered the record developed with a supplemental report from Dr. Cheng. The Appeals Board, designating this a significant panel decision, denied defendant's petition for removal and affirmed the WCJ.