UR and the RFA: the clocks after you ask for treatment

The clock starts when the RFA is received — so know what “received” means

A request for authorization sent by fax, email or EDI is received on the date it is electronically date-stamped on arrival; one sent after 5:30 PM Pacific is deemed received the next business day, except for expedited or concurrent review (8 CCR §9792.9.1(a)(1)). Mail without documentation of receipt is deemed received five business days after deposit (§9792.9.1(a)(2)(A)).

If you need expedited review, say so on the request (§9792.9.1(a)(1)).

How long UR has to decide

Prospective or concurrent decisions: not to exceed five normal business days from receipt of the request and the information reasonably necessary to decide it, “but in no event more than 14 days from the date of the medical treatment recommendation by the physician” (Lab. Code §4610(i)(1)). Note the two triggers: the five days run from receipt, the 14 days from your recommendation.

Expedited: not to exceed 72 hours after receipt of the necessary information (§4610(i)(3); 8 CCR §9792.9.3(c)). Retrospective: within 30 days (8 CCR §9792.9.3(d)).

The decision must reach the requesting physician within 24 hours by phone, fax or agreed secure email; a modification or denial is put in writing to the employee within 24 hours for concurrent review or two normal business days for prospective review (§4610(i)(4)).

Since 1 April 2026 the regulation’s timeframes sit in 8 CCR §9792.9.3; the DWC RFA form still cites the older section.

When UR may take longer — and when it must deny

The timeframes can be extended only if information reasonably necessary to decide is missing, an additional exam or test is needed, or a specialist reviewer is needed (8 CCR §9792.9.6(a)(1)). The reviewer must ask you for the missing information within five business days of receipt (§9792.9.6(b)(1)).

If requested information does not arrive within 14 days of the completed request (30 days for retrospective review), the reviewer “shall deny” it (§9792.9.6(c)(1)). Answering an information request quickly is how a treatment survives UR.

After a denial

A UR denial or modification goes to independent medical review, on the employee’s application within 30 days of service of the decision (see the IMR guide).

How ChironAI™ OM helps

Your plan prose becomes structured orders checked against MTUS/ACOEM and the RFA is built from them. One deadline engine counts the UR clocks in business or calendar days as the rule requires, a daily sweep opens IMR appeal records for eligible denials, and OM warns before you re-request a treatment that UR denied and IMR upheld.