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1. AN UNTIMELY IMR DECISION DOES NOT NULLIFY THE IMR DECISION ON MEDICAL NECESSITY:
In a published decision, the 2nd Appellate Court, in thedecision of SCIF v. Dorothy Margaris, reversed the priorPanel decision in which the Appeals Board had determined the late issuance of theIMR decision to uphold Utilization Review's non-certification of medical treatmentwas improper, as IMR shall issue its decision within the 30 Day timeline as per laborCode section 46710(d).
The Appellate Court indicated in Margaris that the statutory language using theterm "shall" was ambiguous. Therefore, the Court looked past such language inreaching their decision noting the word "shall" in the context of this particularstatute was directory versus mandatory.COMMENTS: The prior Panel decision left the Defense with being punished forsomething not within its control; a late IMR report.This Published Appellate Court decision equitably finds a late IMR report will notnegate the IMR decision, as the Legislative intent on statutes regarding the IMRprocess are intended to defer treatment issues to the IMR doctor, as opposed to aWorkers Compensation Judge, who does not have a medical degree and should notbe making such decisions.
The Court also points to the fact there is no penalty nor consequence fornoncompliance indicated in the statute itself. The lack of such a provision in thestatute, the Court found, was indicative of the legislature's the time frame of 30 daysto issue an IMR decision is to be obligatory permissive, as opposed to mandatory.Therefore, even if an IMR decision is not issued within 30 days of submission toMaximus, the IMR doctor's findings and conclusions are not negated, and areconclusive, regarding the medical necessity for treatment.
2. IMR DOCTOR NOT LICENSED TO PRACTICE MEDICINE IN CALIFORNIADOES NOT NULLIFY THE IMR DECISION:In a recent Noteworthy Panel Decision, the Appeals Board, in Navroth v. Mervyn'sStore, determined a Utilization Review Independent Medical Review (IMR) doctor,can be a licensed physician in another state, and does not have to be licensed topractice in the State of California.
COMMENTS: One of the attacks on IMR decisions made by applicant attorneysinvolved the licensing of doctors who performed Independent Medical Reviews. ThisSignificant Panel Decision, although not binding on the Courts, does allow IMRdoctors who are not licensed to practice in the state of California, but licensed topractice medicine in other states, to perform Independent Medical Reviews.It is very much anticipated that the Applicant, in Pro Per, will appeal this decision.Enjoy your Summer!Par
