Dubon — when UR is so defective the Board may decide treatment

How later panels applied it

Newest released decisions whose legal-standard extraction named this holding. Each quotes the passage and links to the official PDF. The leading case is cited the way courts cite it; our own cards stay ADJ, date, and issue. Litigated tail — not a win rate.

• ADJ14305554 · 2026-06-09 · Santa Rosa District OfficeDubon

  Determinative passage · p.1Applicant contends that the evidence required the WCJ to find that the UR determination was untimely under Labor Code section 4610, and that accordingly, as permitted by the Appeals Board's en banc holding in Dubon v. World Restoration, Inc., et al. (2014) 79 Cal.Comp.Cases 1298 (Dubon II), the WCJ should have found that the requested treatment, a left shoulder total replacement and left biceps tenotomy surgery, is reasonable and necessary based on medical reports that were offered into evidence but neither admitted nor considered by the WCJ.

  The WCAB must determine medical necessity when UR is untimely, requiring further medical evidence development.

  Official decision · page 1 →
• ADJ18785621 · 2026-04-14 · San Francisco District OfficeDubon

  Determinative passage · p.6In Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298, 1299 (Appeals Board en banc) (Dubon II), the Appeals Board held that if a UR decision is untimely, the UR decision is invalid and not subject to independent medical review (IMR). The Dubon II decision further held that the Appeals Board has jurisdiction to determine whether a UR decision is timely. (Id.) If a UR decision is untimely, the determination of medical necessity for the treatment requested may be made by the Appeals Board. (Id. at p. 1300.) As stated by the Appeals Board in Dubon II, "timeliness cannot be fixed. Whether a UR decision is timely is a legal determination and must be decided by a WCJ. An untimely UR decision is the same as no UR." (Id. at p. 1311.)

  The Board applied this standard to reject defendant's reliance on an untimely UR decision and to affirm the WCJ's medical necessity determination.

  Official decision · page 6 →
• ADJ19406087 · 2026-02-03 · Santa Ana District OfficeDubon

  Determinative passage · p.5In Dubon v. World Restoration, Inc. (Dubon II) (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc), the Appeals Board held that it has jurisdiction to determine whether a UR decision is timely. If a UR decision is untimely, the determination of medical necessity for the treatment requested may be made by the Appeals Board. (Dubon II, supra, pages 1299, 1300.)

  Applied to determine jurisdiction over medical necessity disputes.

  Official decision · page 5 →
• ADJ16384093 · 2026-01-20 · Marina del Rey District OfficeDubon

  Determinative passage · p.6Cal.Comp.Cases 1298, the Appeals Board held that it has jurisdiction to determine whether a UR decision is timely. If a UR decision is untimely, the determination of medical necessity for the treatment requested may be made by the Appeals Board. (Dubon II, supra, at pages 1299, 1300.) As noted by the WCJ in her original opinion, she found that the medical reporting was substantial evidence to rebut the Medical Treatment Utilization Schedule (MTUS) despite applicant not having completed the recommended course of injections prior to surgical intervention. Defendant had a genuine basis to argue that the record did not support the treatment based on MTUS. Until that determination was made by the WCJ, there was a legitimate dispute and defense. Defendant's position was not without merit pursuant to Dubon II and therefore cannot be the basis for sanctions, costs, or attorney's fees pursuant to section 5813.

  Cited to explain the jurisdiction and medical necessity determination in the context of UR denial litigation.

  Official decision · page 6 →
• ADJ12874605 · 2026-01-13 · Van Nuys District OfficeDubon

  Determinative passage · p.6prescribed for applicant's pain and psyche. In that opinion, which is often referred to as Dubon II because it modified an earlier en banc opinion in the same case, the appeals board held that:

  The WCJ had jurisdiction to determine medical necessity due to untimely UR of Dr. Sangnil's June 21, 2024 RFA.

  Official decision · page 6 →
• ADJ8192069 · 2025-12-24 · Oakland District OfficeDubon

  Determinative passage · p.12Here, the August 5, 2025 UR determination certified the requested home healthcare treatment as medically necessary. Because the UR decision was valid and timely, the determination is binding on the employer and the employer must provide the treatment forthwith to cure or relieve the employee from the effects of the industrial injury. (Lab. Code, § 4600, subd. (a).)

  The Board applied these authorities to hold that the WCAB could not set aside the August 5, 2025 UR certification of home healthcare, as it was timely and valid.

  Official decision · page 12 →
• ADJ3301539 · 2025-12-12 · Long Beach District OfficeDubon

  Determinative passage · p.3With respect to WCAB jurisdiction over medical treatment disputes, pursuant to Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc) (Dubon II), we articulated the following principles regarding disputes regarding medical treatment:

  Applied to analyze jurisdiction over medical treatment disputes.

  Official decision · page 3 →
• ADJ13254756 · 2025-08-05 · Fresno District OfficeDubon

  Determinative passage · p.6In Dubon, supra, we held that: 1. A utilization review (UR) decision is invalid and not subject to independent medical review (IMR) only if it is untimely.

  Applied to determine WCAB jurisdiction over untimely UR denial and medical necessity determination.

  Official decision · page 6 →