CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

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
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
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 Initially, the Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that invalidated Independent Medical Review (IMR) determinations, finding that IMR timeliness is directory, not mandatory.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
Case No. ADJ4001054 (SAC 0153565)
Regular
Jul 02, 2016

MARYANN MAYFIELD-WEIGANT vs. ROSEVILLE COMMUNITY HOSPITAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for BEAVER INSURANCE, a subsidiary of FREMONT COMPENSATION, in liquidation

This case concerns a worker's appeal of two Independent Medical Review (IMR) denials for prescription medication and lumbar surgery. The Administrative Law Judge (ALJ) found insufficient evidence to overturn the IMR decision for medication and noted the surgery IMR was late but upheld its validity. The Workers' Compensation Appeals Board denied reconsideration, affirming the ALJ's decision. They held that the timeliness of an IMR determination is directory, not mandatory, and therefore does not invalidate the decision, citing precedent.

Independent Medical ReviewIMRPetition for ReconsiderationWorkers' Compensation Appeals BoardWCJLumbar spine injuryUtilization reviewPrescription medicine authorizationLumbar surgery authorizationPlainly erroneous
References
Case No. ADJ4092389 (SBR 0291114), ADJ4203796 (SBR 0291115), ADJ3646941 (SBR 0309645)
Regular
Jul 20, 2018

Gregory Long vs. RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a Findings and Order that found the defendant complied with a prior Independent Medical Review (IMR) decision. The WCAB affirmed the administrative law judge's ruling that each prescription for applicant Gregory Long's opioid pain medication requires separate Utilization Review (UR) and potential IMR, despite a previous IMR approval. The Board also noted its lack of jurisdiction to hear constitutional challenges to the UR/IMR process. Applicant's claims of unequal protection and fraud were rejected, and the WCAB found no impairment to his access to medical treatment.

Workers' Compensation Appeals BoardGregory LongRalphs Grocery CompanySedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrderExpedited HearingWCJIMR determinationUtilization Review (UR)
References
Case No. ADJ9920940
Regular
Apr 14, 2016

ROBERT TOM vs. BUILDING AND COMPUTER ELECTRIC, INC.; REPUBLIC UNDERWRITERS INSURANCE, administered by SEDGWICK CMS, INC.

This case concerns a dispute over the timeliness of an Independent Medical Review (IMR) determination. The applicant argued the IMR was untimely, granting the Workers' Compensation Appeals Board (WCAB) jurisdiction to review the medical treatment dispute. The WCAB reviewed the evidence and found no clear and convincing proof that the director violated statutory timelines in issuing the IMR determination. Therefore, the WCAB affirmed the original decision finding the IMR to be timely.

IMRPetition for ReconsiderationFindings and OrderUtilization ReviewAdministrative DirectorStatutory TimeframeLabor Code Section 4610Labor Code Section 4610.6ADR 9792.10.5(a)(1)Burden of Proof
References
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
Case No. ADJ7161749
Regular
Jul 20, 2018

TOM MODGLIN vs. VENTANA FINE WINDOWS \& DOORS, UNITED STATES FIDELITY GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration. The Board found that the time limit for an Independent Medical Review (IMR) determination is directory, not mandatory, and therefore the IMR decision was valid despite its late issuance. Consequently, the applicant is bound by the IMR decision regarding the medical necessity of the proposed treatment. The Board rescinded the prior decision and returned the case to the trial level.

IMRPetition for ReconsiderationLabor Code section 4610.6(d)directory vs. mandatoryUtilization ReviewACOEM guidelinesMTUScompromise and releaseFuture Medical CareJurisdiction
References
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
Case No. ADJ3852069 (STK 0175466)
Regular
Dec 29, 2015

RAFAEL GOMEZ vs. DAVID REICH CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration, finding that the Independent Medical Review (IMR) determination was untimely. The WCAB rescinded the previous ruling and entered a new finding that the IMR was not completed within the mandatory timeframes outlined in Labor Code section 4610.6(d). Consequently, the medical treatment dispute is no longer subject to the IMR process and is returned to the trial level for a WCJ to decide. This ruling prioritizes the applicant's right to timely medical treatment, emphasizing that mandatory timeframes are crucial for protecting injured workers.

IMRLabor Code section 4610.6(d)WCAB jurisdictiontimely completionmedical treatment disputeadministrative law judgepetition for reconsiderationfindings of factutilization reviewMaximus
References
Showing 1-10 of 148 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational