What the panel ordered
The Appeals Board denied the Petition for Reconsideration, affirming the lack of jurisdiction to review the UR and IMR decisions and rejecting applicant's contentions of bad faith or improper UR.
Applicant sought reconsideration or removal of the WCJ's Findings of Fact issued February 5, 2021, which found the Appeals Board lacked jurisdiction to review the utilization review (UR) and independent medical review (IMR) decisions.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Appeals Board lacks jurisdiction to review the UR and IMR decisions because the applicant did not dispute the timeliness of the UR decisions or appeal the IMR determinations as required by Labor Code section 4610.6(h).
From the decision · page 1Applicant seeks reconsideration or in the alternative removal of the Findings of Fact issued by the workers' compensation administrative law judge (WCJ) on February 5, 2021. By the Findings of Fact, the WCJ found that the Appeals Board lacked jurisdiction to review the utilization review (UR) decisions or independent medical review (IMR) determinations at issue.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant did not appeal the IMR determinations or dispute the timeliness of the UR decisions.
Favours Defendant prevailed
This failure deprived the Appeals Board of jurisdiction to review the UR and IMR decisions.
From the decision · page 4In the case at hand, there is no evidence that applicant requested IMR of the UR decisions denying certification of Buprenorphine. Nor did applicant appeal the IMR determinations which did issue. Although applicant sought IMR for 2 UR decisions reducing the dosage of Buprenorphine, the IMR was not appealed. Applicant has thus failed to fully avail herself of the remedies available to her, and has failed to provide any basis to establish jurisdiction over the UR and IMR dispute submitted at trial.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Submitted multiple requests for authorization of Buprenorphine pills between July and November 2020.
From the decision · page 1Applicant sustained an admitted injury to the lumbar spine and left lower leg while working for defendant employer. She designated Dr. Toufan Razi as her
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4610.6(h)
Labor Code section 4610.6(h) limits Appeals Board jurisdiction to review IMR determinations to verified appeals filed within 30 days.
Applicant did not file a timely appeal of IMR determinations, so the Appeals Board lacks jurisdiction to review them.
From the decision · page 4The Appeals Board is only granted jurisdiction to review IMR decisions in limited circumstances, as set forth as follows in Labor Code section 4610.6(h):
What proof carried it
The evidence the panel weighed, by kind.
Applicant did not dispute timeliness of UR decisions or appeal IMR determinations, failing to fully avail remedies.
From the decision · page 4In the case at hand, there is no evidence that applicant requested IMR of the UR decisions denying certification of Buprenorphine. Nor did applicant appeal the IMR determinations which did issue. Although applicant sought IMR for 2 UR decisions reducing the dosage of Buprenorphine, the IMR was not appealed. Applicant has thus failed to fully avail herself of the remedies available to her, and has failed to provide any basis to establish jurisdiction over the UR and IMR dispute submitted at trial.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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