Does a UR Report Have to be Signed by the Physician?

Response to client question regarding UR reports.

ClientQuestion2Title

Ingber-Weinberg-ColumnsA number of applicant’s attorneys are taking the legal position that unless the reviewing physician actually signs the UR report, the document is defective and therefore inadmissible. There is no such requirement either in the Labor Code or under the regulations. The regulations, 8 CCR 9792.6.1(w) defines a reviewer as a medical doctor, competent to evaluate the specific clinical issues involved in the treatment service and where the services are within the scope of the reviewer’s practice. The doctor must be licensed. There is no requirement of any signature. This is a “red herring” for which there is no legal support. But, some applicant attorneys are claiming that there is a decision on point. They may cite Academy of Arts College v. WCAB (Zedd) (2011) 76 CCC 352. This was a writ denied case in which the UR report was signed by a nurse. In that case, the burden of proof shifted to defendant to prove that the UR decision was reviewed by a doctor, not a nurse. But the case does not require any UR determination to be “signed.” What may be good practice advice is to have statement added to the UR findings that the reviewer is the one who read the materials, applied the standards, made the decision, and wrote the review. A signature is optional but something declarative would be a stronger basis to reject the continuing claims by some attorneys that without the signature, the UR findings are defective.

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