Workers’ Compensation · Primary-source case analysis

Bodam: Utilization Review Is Timely Only When the Decision Is Made and Communicated on Time

By Aneeta Mishra and Timothy Chan

Published August 25, 2026 · Updated October 21, 2026

Decision: Bodam v. San Bernardino Cnty., No. ADJ8120989 (SBR 0041910) (WCAB Nov. 20, 2014).

Bodam v. San Bernardino County examined utilization review (UR) of a spinal-surgery request and the separate deadlines for making and communicating the decision. A request for authorization (RFA) is the physician’s treatment request.

A timely internal decision alone was insufficient

The utilization-review process was not completed merely because the reviewer reached a conclusion before the deadline.

Communication was part of timeliness

The reviewer denied the request on October 31, 2013. There was no evidence of notice to the physician within 24 hours, and written notices were not mailed until November 5, beyond the two-business-day period applicable to prospective review. Timeliness required both a decision and the required communications. Bodam, slip opinion, pages 3–4.

Untimeliness affected the dispute path

An untimely UR decision allowed the WCAB to decide medical necessity on substantial medical evidence instead of sending that issue exclusively to independent medical review (IMR). It did not automatically authorize surgery. The Board denied removal and upheld the judge’s decision to obtain a supplemental medical report because the evidence did not yet establish necessity. Bodam, slip opinion, pages 3–6.

The decision’s timing rule must be read with current law

Bodam is a significant panel decision addressing when a utilization-review decision was communicated. Amendments and later appellate or WCAB authority must be checked for the injury and treatment dates.

Key takeaways

• Calendar both the decision and communication deadlines.
• Preserve fax, mail, and electronic transmission proof.
• Identify the exact RFA receipt date and completeness.
• Check current statutes and later authority before selecting the remedy.