Elliott

In State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (2008) 44 Cal.4th 230, 233-234 [ 79 Cal.Rptr.3d 171 , 186 P.3d 535 ] (State Comp.), our Supreme Court clarified that when an employer is faced with deciding whether to approve or deny the treatment recommendation of an injured worker’s physician, it must conduct utilization review pursuant to Labor Code section 4610. By the same token the employer cannot, as an alternative to utilization review, dispute the treatment request under the general dispute resolution framework set forth in section 4062, subdivision (a) (section 4062(a)).

In this case we are asked to clarify the dispute resolution procedure that comes into play when the employee’s treating physician specifically recommends spinal surgery but the employer’s utilization review decision is to deny treatment. As we explain, special procedures and timeframes govern this situation calling for the employer to instigate the spinal surgery second opinion process detailed in section 4062, subdivision (b) (section 4062(b)); however, they were not followed in this case. Instead, the Workers’ Compensation Appeals Board (WCAB or board) ruled that under Brasher v.…