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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ4523909
Regular
Mar 04, 2016

GLORIA BLACKMON vs. ABZ AUTO WRECKAGE, TRUCK INSURANCE COMPANY, FARMERS INSURANCE EXCHANGE

This case concerns an applicant's petition for reconsideration of a denial of medical treatment authorization. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's decision. The key issue was whether an untimely Independent Medical Review (IMR) determination invalidates the IMR process, thereby allowing the WCAB to decide treatment necessity. The majority found the IMR timelines to be directory, not mandatory, and thus the untimely IMR was valid and binding. A dissenting commissioner argued the IMR timelines are mandatory, and an untimely IMR should allow the WCAB to determine treatment necessity.

Workers' Compensation Appeals BoardIndependent Medical ReviewUtilization ReviewSB 863Labor Code section 4610.6(h)Administrative Directormandatory vs. directorymedical treatment disputeprescription medicationsWellbutrin
References
27
Case No. ADJ9661661
Regular
Jun 30, 2016

CHRISTOPHER TYNI vs. CITY OF MONTEBELLO

This case concerns an untimely Independent Medical Review (IMR) determination regarding applicant's medical treatment. While the Board acknowledges the IMR was issued outside statutory timeframes, it clarifies that these time limits are directory, not mandatory, and do not affect the IMR's validity. Therefore, the Board affirmed the original decision that it lacks jurisdiction to decide medical treatment disputes once submitted to IMR. The case was returned to the trial level with an amended finding correcting the IMR timing calculation.

Workers' Compensation Appeals BoardIndependent Medical ReviewIMRuntimely IMRmedical treatment disputejurisdictionLabor Code section 4610.6(d)directory timeframesmandatory timeframesUtilization Review
References
1
Case No. ADJ10061866
Regular
Jun 20, 2016

MARK CRONIN vs. CITY OF LOS ANGELES

Here's a summary of the case for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of a decision finding a late Independent Medical Review (IMR) determination valid. The Board ruled that timeframes for IMR issuance are directory, not mandatory, and a late IMR does not invalidate the determination. Therefore, the applicant cannot object to the IMR's timeliness after it has been issued. The Board followed precedent holding that untimeliness of an IMR does not invalidate it, thus an objection on that basis is waived.

Workers' Compensation Appeals BoardIndependent Medical ReviewIMRuntimely IMRreconsiderationmedical treatment disputeLabor Code section 4610.6(d)directory timeframesmandatory timeframesutilization review
References
37
Case No. ADJ7210094
Regular
Jan 05, 2012

JOSE G. SANCHEZ vs. DIRECTORY DISTRIBUTION ASSOCIATION, ACE AMERICAN INSURACE COMPANY

This case involves Jose G. Sanchez's workers' compensation claim against Directory Distribution Association and ACE American Insurance Company. The Workers' Compensation Appeals Board denied Sanchez's petition for reconsideration of the judge's decision. The denial was based on the judge's report, which found Sanchez's testimony not credible, giving great weight to the judge's credibility determination as per established case law. Specifically, the judge found that Sanchez failed to prove he reported his injury prior to termination, thus barring his claim under Labor Code Section 3600(a)(10) due to post-termination defense.

Workers' Compensation Appeals BoardReconsideration DeniedCredibility FindingLabor Code Section 5905Title 8 California Code of Regulations 10850Proof of ServiceAdverse PartiesDismissalLabor Code Section 3600(a)(10)Post-Termination Defense
References
6
Case No. ADJ8265185
Regular
Jul 11, 2014

WALTER VELIZ vs. POTENTIAL INDUSTRIES, BERKLEY SPECIALTY

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing a lien claim for failure to appear. The Board found the lien claimant's representative did not make a proper appearance, as they were not present when the case was called despite signing the minutes. Additionally, the claimant failed to comply with mandatory notice provisions and did not provide sufficient good cause for their non-compliance. Consequently, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardReconsideration DeniedLien DismissalNotice of Intention to Dismiss LienLabor Code section 4903.6(b)WCAB Rules 10770.1(e)WCAB Rules 10774.5Electronic Adjudication Management SystemLien ClaimantHearing Representative
References
0
Case No. ADJ6765018
Regular
Nov 13, 2015

MARTIN GUERRERO vs. McKESSON CORPORATION, OLD REPUBLIC INSURANCE

The Appeals Board reversed the WCJ's decision, holding that the statutory timeframes for Independent Medical Review (IMR) determinations are directory, not mandatory. Therefore, IMR decisions issued late are still valid and binding on the applicant. The Board concluded that the Legislature's intent was for IMR to be the sole avenue for resolving medical treatment disputes post-utilization review, ensuring consistent application of evidence-based standards. The case was returned to the trial level for further proceedings consistent with this decision.

Independent Medical ReviewIMRAdministrative DirectorLabor Code Section 4610.6Directory vs. Mandatory TimeframesMedical Treatment DisputesUtilization ReviewMedical NecessityWorkers' Compensation Appeals BoardSB 863
References
22
Case No. ADJ9290138
Regular
Jul 14, 2016

MATT JACOBS vs. PARSEC, INC./BUDCO; ACE USA

This case denied an applicant's petition for reconsideration of a decision upholding an Independent Medical Review (IMR) denial of knee surgery authorization. The applicant argued the IMR determination was invalid due to untimeliness, but the Board found the statutory timeframes for IMR decisions are directory, not mandatory. Therefore, a delay in the IMR decision does not invalidate it, and the applicant remains bound by the IMR's finding on the medical necessity of the proposed treatment. The Board affirmed the WCJ's decision, denying the applicant's petition for reconsideration.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code section 4610.6(h)Utilization ReviewTotal ArthroplastyTimelinessAdministrative DirectorPlainly Erroneous Finding of FactDirectory vs. MandatoryMargaris
References
4
Case No. ADJ8858239, ADJ8858240
Regular
Oct 13, 2016

ANTOINETTE MIRANDA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured

This case concerns the timeliness of an Independent Medical Review (IMR) determination for a left knee total arthroplasty. The WCJ found the IMR determination was late and the WCAB had jurisdiction, but denied the surgery due to insufficient evidence of medical necessity. The Appeals Board granted reconsideration, affirming the denial of treatment but clarifying that the timeframe for IMR issuance under Labor Code section 4610.6(d) is directory, not mandatory. Therefore, the late IMR determination is valid, and the applicant is bound by its decision regarding the medical necessity of the proposed surgery.

Independent Medical ReviewUtilization ReviewLabor Code Section 4610.6(d)Directory vs. Mandatory TimeframeMedical NecessityLeft Knee Total ArthroplastyWCJWCABPetition for ReconsiderationReport and Recommendation
References
4
Case No. ADJ1 0024400
Regular
Mar 23, 2016

DARRIN WALKER vs. COUNTY OF LOS ANGELES--SHERIFF'S DEPARTMENT

This case concerns Darrin Walker's claim for workers' compensation benefits related to a lumbar spine injury. The primary dispute centers on the validity of an Independent Medical Review (IMR) decision that denied authorization for surgery due to a potential delay in the IMR process. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, holding that the statutory timeframes for IMR decisions are directory, not mandatory, citing case law. Consequently, the WCAB affirmed the administrative law judge's prior order denying the applicant's appeal of the IMR determination.

References
31
Case No. ADJ3223915
Regular
Aug 08, 2016

Francisco Correa vs. ANDIAMO, INC., STATE COMPENSATION INSURANCE FUND

This case concerns a dispute over applicant Francisco Correa's prescription for Zanaflex. Initially, the Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that invalidated Independent Medical Review (IMR) determinations, finding that IMR timeliness is directory, not mandatory. However, upon reconsideration, the WCAB recognized that the prior decision failed to address unchallenged findings that the IMRs were substantively defective. Consequently, the WCAB is now remanding the case to the Administrative Director for a new IMR, finding that the applicant's appeal of the original IMR determinations is valid.

Independent Medical ReviewIMRMedical Treatment Utilization ScheduleMTUSZanaflexLabor Code section 4610.6Stevens v. Workers' Comp. Appeals Bd.Administrative DirectorUtilization ReviewPetition for Reconsideration
References
11
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