Appellate Court finds a decision made by Independent Medical Review after the 30 day time limit is sufficient

This is a published decision of the appellate court.

This is a very significant case for workers’ compensation principles.

The applicant had an admitted injury to her left foot and back. Applicant requested an epidural injection The carrier denied the request. Applicant requested an independent medical review.

The independent medical review (IMR) issued after 30 days denying the epidural. The applicant appealed the IMR determination to the Workers’ Compensation Appeals Board (WCAB). A Workers’ Compensation Judge (WCJ) determined the IMR determination was 13 days late, but the decision was still binding.

The applicant petitioned for reconsideration and the WCAB decided that the treatment was necessary. The defendant filed a writ with the appellate court.

The appellate court reviewed the statutes effecting Utilization Review. They reviewed Labor Code section 4610. They determined that an IMR decision as a matter of law is the final determination and binding on all parties.

The court focused on whether the word “shall” in the statute is directory and not mandatory. The statute contained no consequence or penalty if the IMR decision was not timely. If it was interpreted as mandatory that would yield absurd results. Therefore it was considered directory. The case was remanded back to the WCAB since the 30 day time limit was not mandatory.

Case: Callifornia Highway Patrol v. WCAB (Margaris)

Harvey Brown
3501 Jamboree Rd. Suite 602
Newport Beach, CA 92660

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