Marsha Rosenblum worked for the Lompoc Unified School District in 2008 when she had an admitted right groin and hip injury.
In February 2019 her PTP Christopher Birch, M.D., reported that he reviewed the medical records and x-rays of the right hip. He concluded that, “having failed all the applicable non-operative measures . . . [applicant] meets the criteria for a right total hip arthroplasty.” Dr. Birch confirmed his opinion in a subsequent April 2019 report, and submitted an RFA for a right total hip arthroplasty.
The RFA was submitted to UR. On April 8, 2019, a timely UR Determination issued, authorizing the right total hip replacement surgery.
On April 11, 2019, defendant objected to the medical determination made by Dr. Birch. The claims administrator sent a fax to Dr. Birch, stating that a “decision whether to authorize the RFA or send it to medical utilization review” was deferred pursuant to section 4610(g)(7) and Administrative Director rule 9792.9.1(b). It was therefore deferring surgical authorization pending a medical-legal opinion on industrial causation of the hip osteoarthritis pursuant to sections 4061 and 4062, and whether the right hip replacement surgery was related to applicant’s industrial injury.
On May 7, 2019, the matter proceeded to an expedited hearing on the primary issue of applicant’s need for a right hip replacement surgery as authorized by UR. Defendant contended the UR was fatally flawed because there was no connection between the requested surgery and applicant’s industrial injury. On May 20, 2019, the WCJ issued the disputed Expedited Findings of Fact and Order, finding that the court has no jurisdiction to determine medical treatment authorized by a timely UR. Applicant and defendant each petitioned for reconsideration.
Applicant argued that the WCJ erred by not enforcing the medical treatment authorized by UR and awarding the right hip surgery. Defendant contends the WCJ erred by finding the court lacked jurisdiction over the timely UR authorization for a right hip total arthroplasty, arguing that Labor Code1 sections 4061 and 4062 provide an alternate track to dispute an injured worker’s treatment request. Defendant argues that it properly objected to and withdrew its UR approval for the hip surgery after the UR authorization issued.
Reconsideration was granted and the WCAB addressed these contentions in the panel decision of Rosenblum v Lompoc Unified School District. It dened defendant’s Petition for Reconsideration, and granted applicant’s Petition for Reconsideration, and amend the Expedited Findings of Fact and Order to reflect that applicant is entitled to the medical treatment authorized by timely UR.
“Defendant attempted to override the timely April 8, 2019 UR determination and “withdraw” the authorization. Although section 4610(1) allows for deferral of UR while the employer disputes liability for an injury or treatment, here defendant did not dispute liability until three days after the UR authorized the right hip replacement surgery on April 8, 2019. There is no “alternative track” under section 4062 for an employer to dispute a UR determination. When defendant approved the requested treatment through UR, there was no further dispute as to the necessity of the treatment. (§ 4610.5, subd. (f)(1).) An employer may not bypass the UR process and invoke section 4062 to dispute an employee’s treatment request. (Sandhagen, supra, 44 Cal.4th 230, 237.)”.