State Compensation Insurance Fund v. Workers' Compensation Appeals Board

This case presents two related workers’ compensation issues; (1) When deciding whether to approve or deny an injured employee’s request for medical treatment, must an employer conduct utilization review pursuant to Labor Code section 4610? 1 (2) As an alternative to utilization review, may an employer elect to dispute a request for medical treatment under section 4062, which permits an employer to object to “a medical determination . . . concerning any medical issues . . . not subject to Section 4610 . . .”? (§ 4062, subd. (a).) We conclude the Legislature intended to require employers to conduct utilization review when considering requests for medical treatment, and not to permit employers to use section 4062 to dispute employees’ treatment requests. The language of sections 4610 and 4062 mandates this result; this conclusion is especially clear when the language of those statutes is read in light of the statutory scheme and the omnibus reforms *234 enacted by the Legislature in 2003 and 2004. (Sen. Bill No. 228 (2003-2004 Reg. Sess.) (Senate Bill No. 228); Sen. Bill No. 899 (2003-2004 Reg. Sess.) (Senate Bill No. 899).) Accordingly, we reverse the Court of Appeal’s…

I agree with the majority’s conclusion and much of its analysis. Specifically, I agree that the “utilization review” process set forth in Labor Code 1 section 4610 is mandatory. I also agree that, if an employer fails to meet section 4610’s deadlines, it may not object to the employee’s requested medical treatment under section 4062. Certain language in the majority’s opinion, however, might be misread to suggest that utilization review is a dispute-resolution process that replaces the “cumbersome, lengthy, and potentially costly” dispute-resolution process that previously applied under former section 4062. (Maj. opn., ante, at p. 238.) As I understand the statutory scheme, the utilization review process adds a new step that the employer must take before section 4062 comes into play, but it does not replace the section 4062 process. Section 4062 remains the means for resolving any dispute between the parties regarding medical treatment, as I explain below.

Section 4600 requires employers to provide their employees with medical treatment for their work-related injuries. When disputes arise regarding the conclusions and recommendations of the treating physician, section 4062 sets…

This case presents two related workers' compensation issues: (1) When deciding whether to approve or deny an injured employee's request for medical treatment, must an employer conduct utilization review pursuant to Labor Code section 4610? [1] (2) As an alternative to utilization review, may an employer elect to dispute a request for medical treatment under section 4062, which permits an employer to object to "a medical determination ... concerning any medical issues ... not subject to Section 4610 ..."? (§ 4062, subd. (a).) We conclude the Legislature intended to require employers to conduct utilization review when considering requests for medical treatment, and not to permit employers to use section 4062 to dispute employees' treatment requests. The language of section 4610 and 4062 mandates this result; this conclusion is especially clear when the language of those statutes is read in light of the statutory scheme and the omnibus reforms enacted by the Legislature in 2003 and 2004. (Sen. Bill No. 228 (2003-2004 Reg. Sess.) (Senate Bill No. 228); Sen. Bill No. 899 (2003-2004 Reg. Sess.) (Senate Bill No. 899).) Accordingly, we reverse the Court of Appeal's…