WCAB

INTRODUCTION

In this original proceeding, State Compensation Insurance Fund (SCIF), as the adjusting agent for California Highway Patrol (CHP) (collectively, Petitioner), seeks review of a decision of the Workers’ Compensation Appeals Board (appeals board) regarding the medical necessity of proposed treatment requested by CHP employee Dorothy Margaris (applicant). The issue presented relates to Labor Code section 4610.6, which the Legislature adopted in 2012 as part of an ongoing effort to reform California’s workers’ compensation system. 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 administrative director of the Division of Workers’ Compensation (director) oversees IMR, which is conducted by a private organization that retains licensed physicians to review the pertinent medical records and issue written determinations regarding the medical necessity and appropriateness of proposed medical treatment. The IMR determination becomes the final determination of the director by operation of…