Decision  Arthur Davidson v. Southern Redi Mix Corp.

Date:	05/23/2000
Organization:	Department of Industrial Accidents
Docket Number:	DIA Board No. 022112-91
Location:	Boston

• Employee: Arthur Davidson
• Employer: Southern Redi Mix Corp.
• Insurer: Transportation Insurance Company

LEVINE, J. The insurer appeals from a decision in which an administrative judge concluded that the employee need not exhaust the utilization review (UR) procedures set out in 452 Code Mass. Regs. §6.00 et seq. before bringing a claim for G.L. c. 152, §30, medical benefits. The insurer argues that the employee must comply with the procedures in those regulations, including exhausting all appeals from an adverse determination, prior to claiming medical benefits in the traditional dispute resolution process. ¹ Because the insurer did not take the initial step to begin the UR procedure -- issuing a utilization review card to the employee -- we do not reach the issue of exhaustion. We affirm the decision on the basis that the insurer’s conduct obviated the UR procedure.

¹ See Code Mass. Regs. §6.04 (4)(a), (c), 1 for the procedure to be followed in appealing an adverse UR determination.