Michael Green injured his spine, neck, right shoulder and hips at work in 2012. Dr. Jones, an authorized second opinion physician, sent a Request for Authorization (‘RFA’) dated April 17, 2015, which recommended artificial disc replacement arthroplasty at L4-L5 with a one to two day inpatient stay. The RF A was received by the insurance carrier via facsimile at 6: I 8 p.m. on Friday, April I 7, 2015. The procedure was denied by Howard Sturtz, M.D. in his UR letter of April 27, 2015 which was was served by facsimile only on April 27, 2015 just after 6:00 p.m. in the evening.

It is undisputed that the last business day for UR in this case was April 27, 2015.

The WCJ found that defendant’s “Utilization Review [UR] denial of April 27, 15 2015 was untimely,” and that the “(d]isc replacement/total disc arthroplasty procedure at L4-L5 16 requested by Dr. Jones under a Request for Authorization [RFA] of April 17, 2015 is reasonable and necessary” medical treatment and it was awarded.

The defendant’s petition for reconsideration was granted, and the decision reversed in the split panel decision of Green v Elle Placement dba Golden Gate Staffing. It was held that Defendant timely made a UR determination and served it within the allowed time. Any further dispute of a valid UR denial is subject to the Independent Medical Review (IMR) process.

AD Rule 9792.9.l(a)(l) provides that when an RFA is submitted after 5:30 p.m., it is considered to be received on the next business day. (Cal. Code Regs., tit. 8, § 9792.l.9(a)(l).) In that the RFA in this case was submitted after 5:30 p.m. on Friday, April 17, 2015, as shown by the fax received date stamped on its face, it is properly deemed under AD Rule 9792.9.I(a)(I) to have been received the next business day on Monday April 20, 2015.

AD Rule 9792.9.l(c){l) states that “the first day in counting any timeframe requirement is the day after the receipt of the DWC form RFA … ” (Cal. Code Regs., tit. 8, § 9792.I.9(c)(l). The day after the date the RFA was received was Tuesday, April 21, 2015. The WCJ was correct in concluding that the Monday, April, 27, 2015 UR decision timely issued within five working days of that date because Saturday, April 25, 2015 and Sunday, April 26, 2015 are not “working days” as described in section 4610(g)(l).

Section 9792.1.9(3)(A) provides in pertinent part that a prospective UR decision like the one in this case “shall be communicated to the requesting physician within 24 hours of the decision … initially by telephone or facsimile, and … in writing … within two business days of the decision … as prescribed by the administrative director.” AD Rule 9792.9.l(e) in tum provides that a prospective UR decision “shall be communicated to the requesting physician within 24 hours of the decision .. .initially by telephone, facsimile, or electronic mail … followed by written notice … “

Both of these regulations “plainly allow for communication of a UR decision ‘within 24 hours of the decision,’ and they do not include that time period within the time for making the decision. In this case, the decision was made on April 27, 2015, and it was communicated by facsimile to the treating physician on the same date, which was within 24 hours of the decision. The record shows that the UR decision was both timely made and timely communicated. As such, the UR is valid and there was no basis for the WCJ to award the disputed medical treatment.”

Commissioner Caplan wrote a dissenting opinion. “Accepting defendant’s contention that the time for sending a UR decision does not begin to run until the UR decision is made would expand the time within which UR is to be completed from five working/business days to five working/business days plus 24 hours. Such an expansion of the time for completion of UR is contrary to the Legislature’s intention in establishing a fixed time frame for completion of UR, and it is contrary to the AD regulations that require completion of UR within five business days of the defendant’s receipt of the RFA.