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THIS IS A NOTICE OF ADVERSE DETERMINATION-SPECIALTY HEALTH URA. Download Sample URA Adverse Determination Notice, Specialty Health (SN010) – Insurance (Texas) form.A letter of good standing from the Texas Comptroller of Public Accounts. Exhibit 6: Biographical Information. (a) Appeal of prospective or concurrent review adverse determinations. Each URA must comply with its written procedures for appeals. (4) the professional specialty of the physician, doctor, or other health care provider that made the adverse determination;. The California Supreme Court held that utilization review must be used for every medical treatment request in the California workers' compensation system. This is called an adverse determination (medical necessity denial). Women's Health and Cancer Rights Act of 1998 .