State Compensation Ins. Fund v. WCABAnnotate this Case
Petitioner seeks review of the appeals board's decision regarding the medical necessity of proposed treatment requested by a CHP employee (applicant). Labor Code section 4610.6 created a new procedure - independent medical review (IMR) - that an injured worker may use to challenge an employer’s timely denial, delay or modification of a request for authorization of proposed medical treatment. The court considered whether, as the appeals board concluded in this case, an IMR determination issued after the 30-day period is invalid and thereby vests jurisdiction in the appeals board to decide whether the proposed treatment is medically necessary and appropriate. The court concluded that the 30-day time limit in section 4610.6, subdivision (d), is directory and, accordingly, an untimely IMR determination is valid and binding upon the parties as the final determination of the director. The court's interpretation of the statute in this manner is consistent with long-standing case law regarding the mandatory-directory dichotomy, and implements the Legislature’s stated policy that decisions regarding the necessity and appropriateness of medical treatment should be made by doctors, not judges. Accordingly, the court annulled the decision of the appeals board and remanded for further proceedings.