Workers’ Compensation

Ca. Workers' Comp. Quarterly 2014, Vol. 27, No. 2

Tomorrow, Tomorrow, Not Today: Putting a Stop to Medical Treatment Delay


Sacramento, California

An important legislative goal in SB 863 is to "prohibit an employer from engaging in any conduct that delays the medical review process." (SB 863, Legislative Digest, paragraph (11).) To achieve that goal, SB 863 enacted a whole new system for resolving medical disputes through Independent Medical Review (IMR). While IMR is designed to help parties resolve medical treatment disputes, the reality is that it has in many cases delayed medical treatment longer than Utilization Review (UR) ever imagined. Given the option, the applicant’s attorney should keep two cases in mind when deciding whether to proceed to IMR: Sandhagen v. SCIF (2008) Cal.Comp.Cases 981 and Dubon v. SCIF (2014) 79 Cal. Comp.Cases 313 (en banc).

Under Sandhagen, the "utilization review process [is the] employers’ only avenue for resolving an employee’s request for treatment…." (Sandhagen, supra.) Where the employer does not follow the UR process, it loses its right to object to the medical treatment indicated. Sandhagen dealt with untimely utilization review. Dubon recently expanded the Sandhagen opinion to cover a materially defective UR decision where the defect undermines the integrity of the decision.

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