There are three possible resolutions to the denial of a variance: informal discussion between the Health Care Provider and the Carrier, review by a WCB Law Judge, or submission for a Decision by a Medical Arbitrator.
INFORMAL DISCUSSION - 8 DAYS
The Health Care Provider and the Carrier have 8 business days to attempt to resolve their dispute regarding the authorization for a variance. If the dispute is resolved, the Carrier completes secion G of form MG-2 indicating that the matter was resolved by agreement.
FORMAL REVIEW - 21 BUSINESS DAYS FROM RECEIPT OF DENIAL
If the informal road leads to nowhere, the Health Care Provider must notify the Claimant and the Claimant's Attorney. The Claimant and his/her Attorney can then decide whether they will seek a formal review of the denial, either by the WCB or a Medical Arbitrator. If a formal review is sought, the Claimant must file Section F of form MG-2 within 21 business days from the date of the receipt of the denial. The Claimant has a choice of whether to use the WCB Law Judge or a Medical Arbitrator to review the variance and denial. That choice is made by checking the appropriate box in Section F of form MG-2. If no choice is made the default option is expedited review by a WCB Law Judge "Rocket Docket". If the Claimant chooses a Medical Arbitrator the Carrier must also agree to that method of resolution, and vice-versa.
A Medical Arbitrator's Decision is not subject to Appeal. The review happens without the participation or appearance of the parties. All documents are reviewed.
If the Expedited Hearing option is chosen, the Hearing will be held within 30 days after the period of informal resolution expires. One or both parties must request this type of resolution (meaning the right to an expedited hearing cannot be waived). Medical testimony will be required by virtue of depositions. Adjournaments will only be permitted for up to 30 days and only for cases involving complex medical issues of causation or diagnosis.
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