COURT OF APPEAL - SECOND DIST. W II 11 IB, 1To JUN 22 2016 JOSEPH A. LANE Clerk Deputy Clerk
ORIGINAL PROCEEDINGS in certiorari. Petition granted; decision of the Workers’ Compensation Appeals Board annulled; matter remanded for further proceedings. Lisa A. Liebson, Deputy Chief Counsel, Mary R. Huckabaa, Assistant Chief Counsel and William L. Anderson, Appellate Counsel for Petitioner. Finnegan, Marks, Theofel & Desmond, Ellen Sims Langille and Randall G. Poppy for California Chamber of Commerce as Amicus Curiae on behalf of Petitioner.
Law Offices of Allweiss & McMurtry and Michael A. Marks for California Workers’ Compensation Institute as Amicus Curiae on behalf of Petitioner. John F. Shields for Respondent, Workers’ Compensation Appeals Board. Law Offices of Jill Suzanne Breslau and Jill Suzanne Breslau for Respondent, Dorothy Margaris. Law Office of Mark Gearheart and Justin C. Sonnicksen for California Applicants’ Attorneys Association as Amicus Curiae on behalf of Respondent, Dorothy Margaris.
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 law and may only be appealed on limited grounds. Section 4610.6, subdivision (d), provides that the organization conducting IMR “shall complete its review and make its determination in writing … within 30 days of the receipt of the request for review and supporting documentation, or within less time as prescribed by the administrative director.” (§ 4610.6, subd. (d).) We consider whether, as the appeals board concluded in this case, an IMR determination issued after the 30-day period is invalid and thereby vests jurisdiction in the appeals board to decide whether the proposed treatment is medically necessary and appropriate. Our analysis turns, in large part, on whether the language of the statute is mandatory-such that All further undesignated section references are to the Labor Code.
a failure to comply with the statute’s directive renders the resulting governmental action invalid-or merely directory. We disagree with the appeals board and conclude the 30-day time limit in section 4610.6, subdivision (d), is directory and, accordingly, an untimely IMR determination is valid and binding upon the parties as the final determination of the director. Our interpretation of the statute in this manner is consistent with long-standing case law regarding the mandatory-directory dichotomy, and implements the Legislature’s stated policy that decisions regarding the necessity and appropriateness of medical treatment should be made by doctors, not judges. We therefore annul the decision of the appeals board and remand for further proceedings.
FACTUAL AND PROCEDURAL BACKGROUND Applicant suffered a work-related injury to her left foot and lumbar spine. On October 16, 2014, applicant’s treating physician submitted a request for authorization of medical treatment to SCIF proposing to treat applicant with a lumbar epidural injection. On October 21, 2014, SCIF denied the request. Applicant timely requested independent medical review. On November 26, 2014, SCIF sent the necessary medical records to Maximus Federal Services, Inc. for review. On January 8, 2015, Maximus issued its IMR determination, upholding SCIF’s denial of the proposed medical treatment. The IMR determination became the final determination of the director as a matter of law. (§ 4610.6, subd. (g).') Applicant appealed the IMR determination to the appeals board(§ 5300), which directed the matter to an administrative law judge for a hearing (§ 5310). Applicant
By separate order of this date, we grant in part and deny in part the requests for judicial notice submitted by CHP on December 21, 2015, January 28, 2016, and April 13, 2016.
Maximus is a private company contracted by the Division of Workers’ Compensation to conduct independent medical review. (See§ 139.5.)
argued (as is pertinent here) that the IMR determination was invalid because Maximus failed to issue it within the 30-day time period provided by section 4610.6, subdivision (d), and the applicable regulation (Cal. Code Regs., tit. 8, § 9792.10.6, subd. (g)). The judge agreed the IMR determination was issued 13 days late, but nevertheless found the determination was valid and binding on the parties, concluding that an untimely IMR determination “does not confer jurisdiction on the [workers’ compensation judge] to decide any medical treatment issues.” Applicant filed a petition seeking reconsideration of the judge’s decision by the appeals board(§ 5900), and again argued that the 30-day time period set forth in section 4610.6, subdivision (d), is a mandatory provision and, accordingly, an untimely IMR determination is invalid. Applicant further asserted that, in the absence of a timely IMR determination, the appeals board had the authority to decide whether the proposed treatment was medically necessary and appropriate. A majority of the three-member panel agreed with applicant and went on to find, contrary to the IMR determination, that the proposed treatment was supported by substantial medical evidence and was consistent with the treatment schedule promulgated by the director. One member of the panel dissented, and would have found that the IMR determination, though untimely, was valid and binding on the parties. Petitioner filed the instant petition seeking review of the appeals board’s decision. We issued a writ of review because this case presents an important issue of first impression regarding the interpretation of section 4610.6, and because it relates to an issue upon which the appeals board has rendered conflicting decisions.
As we explain in detail, post, the director adopted a medical treatment utilization schedule (MTUS) which sets forth the frequency, duration, intensity, and appropriateness of medical treatment commonly provided to injured workers. (§ 5307.27, subd. (a).)
DISCUSSION Petitioner contends an IMR determination is valid and binding upon the parties as the final determination of the director, even if that determination is rendered after the 30-day time period provided by section 4610.6, subdivision (d). We agree. A. Standard of Review The proper interpretation of a workers’ compensation statute presents a question of law subject to our independent review. (Smith v. Workers’ Comp. Appeals Bd. (2009) 46 Cal.4th 272, 277; State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (2008) 44 Cal.4th 230, 236, fn. 6 (Sandhagen).) Typically, we would afford the appeals board’s interpretation of the statute “great weight,” as it was “rendered in an official adjudicatory proceeding by an administrative body with considerable expertise interpreting and implementing a particular statutory scheme.” (Larkin v. Workers’ Comp. Appeals Bd. (2015) 62 Cal.4th 152, 158 (Larkin); see also Brodie v. Workers’ Comp. Appeals Bd. (2007) 40 Cal.4th 1313, 1331 [noting the appeals board’s " ‘extensive expertise in interpreting and applying the workers’ compensation scheme’ "].) However, we do not defer to the appeals board’s statutory interpretation in this case because the appeals board has rendered conflicting decisions on the issue presented here. The principles guiding our review are well settled. "In interpreting a statute, we begin with its text, as statutory language typically is the best and most reliable indicator of the Legislature’s intended purpose. (Fitch v. Select Products Co. (2005) 36 Cal.4th 812,818; see Baker v. Workers’ Comp. Appeals Bd. (2011) 52 Cal.4th 434, 442.) We consider the ordinary meaning of the language in question as well as the text of related
See, e.g., Arredondo v. Workers’ Comp. Appeals Bd. (2015) 80 Cal.Comp.Cases 1050 [concluding section 4610.6, subdivision (d), is directory]; Hallmark Marketing v. Workers’ Comp. Appeals Bd. (Southard) (2015) 2015 Cal.Wrk.Comp. P.D. Lexis 365 [concluding section 4610.6, subdivision (d), is mandatory], currently pending before the Third District Court of Appeal on writ of review, No. C079912