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Children's National Medical Center v. District of Columbia Dep't of Employment Services

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Argued February 25, 2010

Before RUIZ and FISHER, Associate Judges, and BELSON, Senior Judge.

In the workers’ compensation system, utilization review (“UR”) is a statutory procedure for determining “the necessity, character, or sufficiency of any medical care or service furnished or scheduled to be furnished” to an injured employee. D.C. Code § 32-1507 (b)(6)(A) (2001). In this case, the Department of Employment Services (“DOES”) held that the UR process had been completed although the employee’s physician had not sought reconsideration of an adverse opinion. Holding that the agency’s decision was based on a permissible interpretation of the statute, we affirm.

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