Dubon’s Petition for Writ of Review Denied as Moot: Cal. Comp. Cases February Advanced Postings (2/20/2015)

Here’s the fifth batch of advanced postings for February 2015 issue of Cal. Comp. Cases.

Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnote and summary.

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Jose Dubon, Petitioner v. Workers' Compensation Appeals Board, World Restoration, Inc., State Compensation Insurance Fund, Respondents, lexis.com, Lexis Advance

Publisher’s Note: On Feb. 17, 2015, Petitioner filed a petition for review in the California Supreme Court.

Utilization Review—Independent Medical Review—Court of Appeal, denying applicant’s petition for writ of review as moot, did not disturb WCAB’s en banc split decision in Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cases 1298 (Appeals Board en banc opinion) (Dubon II) rescinding prior en banc decision, Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cases 313 (Appeals Board en banc opinion) (Dubon I), denying applicant’s present petition for reconsideration, and affirming WCJ’s Findings and Order, which determined that medical necessity of applicant’s requested back surgery must be determined by independent medical review, notwithstanding any procedural defects in defendant’s timely utilization review decision, held that utilization review decision is invalid and not subject to independent medical review only if it is untimely, that legal issues regarding timeliness of utilization review decision must be resolved by WCAB, not independent medical review, that all other disputes regarding utilization review decision must be resolved by independent medical review, and that, if utilization review decision is untimely, determination of medical necessity may be made by WCAB based on substantial medical evidence consistent with Labor Code § 4604.5, when WCAB en banc found that legislature has made it abundantly clear that medical decisions are to be made by medical professionals, that to allow WCJ to invalidate utilization review decision based on any factor other than timeliness and substitute his or her own decision on treatment request violates intent of 2012’s SB 863, and that, when utilization review decision is not timely rendered in compliance with mandatory deadlines, there is no dispute for independent medical review to resolve within meaning of Labor Code §§ 4610(g)(3)(A) and (B) and 4610.5(a), (b), and (k)…read more at lexis.com or Lexis Advance.