In regards to utilization review, normally the claims administrator has "five (5) business days" from receipt of an RFA to issue a response (accept/deny/modify) per Regulation 9792.9. The term "business day" is not specifically defined in the post-2013 workers' compensation statutes, and was the subject of a recent court case.
In the "noteworthy panel decision" case of
California Dept. of Corrections v. WCAB (Gomez) (2018) 83 CCC 530, a UR Denial issued in early December 2016 on what was thought to be the fifth day for a decision. The applicant asserted the UR Denial was late by one day if count the Friday after Thanksgiving as a "business day" as oppose to a holiday. The Court agreed, relying upon the definition of "business day" under Civil Code Section 9 which includes every day except Sunday and holidays as designated by the Government Code.
The Court acknowledged there were other statutes and even official State-issued postings stating the Friday after Thanksgiving was consider a holiday. Nevertheless, the Court held those statutes and postings did not specifically pertain to the utilization review process, and thus
the day after Thanksgiving is not a holiday but to be considered a business day in the UR timeline. [COMMENT: Surprisingly, the day after Thanksgiving is not a federal holiday and is considered a holiday in less than 1/2 of the States. California Government Code Section 6700 lists 15 dates as official State holidays that should be considered whenever there is an issue of UR Denial timeliness.]
