CA AB2503

Physicians providing treatment to injured workers must send requests for medical treatment authorization with supporting documentation to the claims administrator according to rules adopted by the administrative director.

Employers must establish written utilization review policies and procedures consistent with the state's medical treatment utilization schedule, with decisions made by or under supervision of a medical director holding an unrestricted California medical license.

Prospective or concurrent utilization review decisions must be communicated to requesting physicians within 24 hours, with denials or modifications communicated by phone/fax initially and in writing within 24 hours for concurrent review or two business days for prospective review.

Decision timeframes are limited to 5 working days (no more than 14 days total) for standard cases and 72 hours for cases involving imminent serious threats to health, with extensions allowed if additional information or expert consultation is needed.

Administrative penalties may be assessed by the administrative director for failure to meet timeframe or other requirements, with penalties deposited into the Workers' Compensation Administration Revolving Fund.