Court of Appeal case on Independent Medical Review to resolve challenges to Utilization Review
- Posted By: Harvey Brown
- December 1, 2015
This is a Court of Appeal published case
This is a very significant case for workers’ compensation principles.
The applicant had an admitted injury to her right foot in 1997. The applicant had 3 surgeries on her right foot and developed pain in her left foot. She had to use a wheelchair which caused low back and bilateral-shoulder pain. She became depressed and after a trial a Workers’ Compensation Judge (WCJ) determined she was permanently totally disabled.
The applicant’s physician requested the applicant receive home health care eight hours a day, five days a week. The defendant sent the request to Utilization Review (UR). The request was denied after review by a physician. The applicant eventually requested Independent Medical Review (IMR). IMR determined that the home health care and four medications requested were not necessary.
The applicant appealed the IMR determination as a denial of due process. The appellate court determined that the Workers’ Compensation Appeals Board (WCAB) did not violate the applicant’s state constitutional rights or her federal due process rights.
The case was remanded by the appellate court to the WCAB to determine if the IMR decision was denied without authority under the Medical Treatment Utilization Schedule (MTUS).
Case: Stevens v. WCAB, Outspoken Enterprises