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✦ Certified Specialist in Workers’ Compensation Law — Certified by the State Bar of California, Board of Legal Specialization ✦
Serving injured workers across California. Board-certified specialist; no fee unless we win.
By Eman Yazdchi, Esq. · Certified Specialist in Workers' Compensation Law, State Bar of California Board of Legal Specialization
In California, Utilization Review (UR) under Labor Code §4610 is the workers' compensation insurer's process for approving, modifying, or denying each treatment request against the Medical Treatment Utilization Schedule. A UR denial is appealed through Independent Medical Review under §4610.5. Yazdchi Law handles California UR disputes statewide.
Under California Labor Code §4610, Utilization Review (UR) is the process by which a California workers' compensation insurer reviews each treatment request from the Primary Treating Physician — typically on a Request for Authorization (RFA) form — against the Medical Treatment Utilization Schedule. The insurer's UR physician approves, modifies, or denies the request. UR is the single most common point at which California treatment is delayed or denied.
Under California Labor Code §4610, prospective UR — review of treatment requested but not yet provided — must be completed within five working days of the RFA, extendable to 14 days for additional information. Expedited UR for urgent treatment must be completed within 72 hours. Retrospective UR — review of treatment already provided — must be completed within 30 days. A California UR decision missing these deadlines is procedurally invalid and the requested treatment is deemed authorized.
Under California Labor Code §4610, the California UR decision must apply the Medical Treatment Utilization Schedule (MTUS) adopted by the Division of Workers' Compensation. The MTUS incorporates the ACOEM Practice Guidelines and the ODG Treatment in Workers' Comp Guidelines as the presumptively correct medical standard. A California UR denial must cite the specific MTUS provision relied on; a boilerplate denial is procedurally defective.
Under California Labor Code §4610.5, a UR denial is appealed through Independent Medical Review (IMR). The injured worker has 30 days from service of the UR denial to file the California IMR application with the Department of Industrial Relations. IMR is decided by a California-licensed physician on a panel maintained by Maximus Federal Services, independent of the insurer. An IMR decision is binding and forecloses re-litigation of medical necessity at the WCAB.
Under California Labor Code §5814, a California injured worker can recover a 25% penalty for unreasonable delay or denial of benefits, including treatment delays caused by improper UR. A single legitimate UR dispute is generally not unreasonable, but a pattern of California UR denials reversed by IMR — combined with delay in re-authorizing treatment after IMR — supports a §5814 penalty awarded by the WCAB judge.
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Tap to call →Last reviewed by Eman Yazdchi, Esq., May 2026.
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