Under LC 4610, who is authorized to modify, delay, or deny medical treatment requests in a UR setting?

Under LC 4610, who is authorized to modify, delay, or deny medical treatment requests in a UR setting?

• A. Licensed physician
• B. Licensed medical provider
• C. Nurse
• D. Claims adjuster

Answer: (A)

The key idea is that medical treatment decisions in utilization review are clinical decisions that must be made by a physician. Under California Labor Code 4610, modifying, delaying, or denying a medical treatment request requires physician-level medical judgment about the necessity and appropriateness of care. A licensed physician has the training and authority to assess medical necessity, whereas a nurse cannot independently deny treatment, a claims adjuster handles administrative/payments, and a broader “licensed medical provider” category would not necessarily guarantee the physician-specific authority required by the statute. So the authorization rests with a licensed physician.

The key idea is that medical treatment decisions in utilization review are clinical decisions that must be made by a physician. Under California Labor Code 4610, modifying, delaying, or denying a medical treatment request requires physician-level medical judgment about the necessity and appropriateness of care. A licensed physician has the training and authority to assess medical necessity, whereas a nurse cannot independently deny treatment, a claims adjuster handles administrative/payments, and a broader “licensed medical provider” category would not necessarily guarantee the physician-specific authority required by the statute. So the authorization rests with a licensed physician.