The document set runs on a set of clocks, and missing one has consequences ranging from an out-of-compliance record to, in one case, treatment being deemed approved by default. These deadlines are not guidelines; they are the operational rhythm of a WC case.
- DFR — Doctor's First ReportWithin 5 working daysDue within 5 working days of first treatment, opening the medical record on the case.
- PR-2 — periodic progress reportAt least every 45 daysFiled at least every 45 days, or within 20 days of a change in the patient's condition or a reasonable written request.
- PR-3 / PR-4 — Permanent & StationaryWithin 20 days of MMIFiled within 20 days of the P&S / MMI determination.
- UR decision under §4610Within 5 business days of the RFAThe utilization-review decision is due within 5 business days of the RFA. If the payer misses the clock, the treatment can be deemed approved.
The reporting cadence has three intervals worth committing to memory. The DFR is due within 5 working days of first treatment. The PR-2 is filed at least every 45 days, with a tighter 20-day trigger when the patient's condition changes or a reasonable written request arrives. The P&S report — PR-3 or PR-4 — is due within 20 days of the MMI determination.
The utilization-review clock is the one with teeth. Under §4610the Labor Code section governing utilization review and its decision timeline, the UR decision is due within 5 business days of the RFA — and if the payer misses that clock, the requested treatment can be deemed approved. The deadline therefore cuts both ways: it disciplines the reviewer as much as it pressures the clinician to submit a clean, well-supported RFA.
CareHub's compliance engine tracks the 5-, 20-, and 45-day windows across the case and surfaces what is due, due-soon, and overdue — so the cadence is visible rather than something a clinician has to hold in their head between sessions.
Under §4610, what can happen if the payer misses the 5-business-day deadline to decide an RFA?