CompFox AI Summary
This case involved an applicant seeking reimbursement for self-procured medication following utilization review (UR) denials. The Workers' Compensation Appeals Board (WCAB) determined that the statutory time limits for Independent Medical Review (IMR) are directory, not mandatory, making the IMR determinations valid despite delays. The WCAB found the defendant liable for reimbursement of self-procured medication due to overturned UR denials, but rescinded the penalty and attorney's fees for unreasonable delay.
Full Decision Text1 Pages
This case involved an applicant seeking reimbursement for self-procured medication following utilization review (UR) denials. The Workers' Compensation Appeals Board (WCAB) determined that the statutory time limits for Independent Medical Review (IMR) are directory, not mandatory, making the IMR determinations valid despite delays. The WCAB found the defendant liable for reimbursement of self-procured medication due to overturned UR denials, but rescinded the penalty and attorney's fees for unreasonable delay.
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