“They approved part of it.”

What a modified authorization actually is

Utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. can approve, modify, or deny a treatment request. A modification approves something other than what your doctor asked for:

• Six visits instead of twelve
• The injection but not the surgery
• Physical therapy instead of the MRI
• A generic instead of the prescribed medication
• A different procedure than the one requested

Every one of those is a denial of the difference, and every one of them is appealable through Independent Medical Review on the same 30-day timeline as an outright denial.

This is the single most common way an appeal deadline is lost in California workers’ compensation. The letter says “approved.” The worker files it. Thirty days pass. The right to challenge what was cut is gone.

Read the letter for the deadline, not the headline

Every UR decision must state what was requested, what was decided, the clinical reason, the guideline relied on, and how to appeal. Find the appeal instructions and the date.

Then check the letter for defects before you do anything else, because a late UR decision may be challenged before a judge rather than through IMR — which is a materially better forum. The other defects below are dealt with in IMR, not by a judge:

• Was it timely? UR has strict deadlines from receipt of the request.
• Was the decision made by a physician competent to evaluate the specific issue? Only a physician may modify or deny for medical necessity.
• Was it served on everyone required, within the required time?
• Did it actually address what was requested?

How to check a UR denial in detail.How IMR works.

What your doctor should do

Respond to the guideline the reviewer cited, specifically. A modification is usually justified by reference to a treatment guideline, and the appeal has to explain why this worker’s presentation falls outside the general rule — not merely repeat the original request.

Document the failed conservative care. Most guideline pathways require a documented trial and failure of something less invasive first. That documentation is what wins the appeal, and it is frequently in the chart but not in the request.

And note what changed since January 2, 2026. Four MTUS treatment guidelines — shoulder, elbow, hand, wrist and forearm, and traumatic brain injury — were replaced effective that date, and the utilization review regulations were restructured effective April 1, 2026. A denial or an appeal citing the superseded material is citing something that no longer exists.