Under LC 4610, can a nurse in UR approve or deny requests for medical treatment?

Under LC 4610, can a nurse in UR approve or deny requests for medical treatment?

• A. Yes, approved by UR nurse
• B. No, only licensed physicians may modify, delay or deny requests
• C. Yes under physician supervision
• D. Not specified

Answer: (B)

In utilization review for California workers’ compensation, the authority to approve, modify, delay, or deny medical treatment rests with a licensed physician. LC 4610 requires that medical determinations reflect medical judgment and be made by a physician, not a nurse. A UR nurse can assist with data collection, documentation review, and coordination, but the final decision about treatment eligibility or changes must come from a physician. Therefore, a nurse in UR cannot independently approve or deny requests for medical treatment.

In utilization review for California workers’ compensation, the authority to approve, modify, delay, or deny medical treatment rests with a licensed physician. LC 4610 requires that medical determinations reflect medical judgment and be made by a physician, not a nurse. A UR nurse can assist with data collection, documentation review, and coordination, but the final decision about treatment eligibility or changes must come from a physician. Therefore, a nurse in UR cannot independently approve or deny requests for medical treatment.