Joann Matute claimed cumulative industrial injury to her psyche, fibromyalgia, carpal tunnel syndrome, allergies and rheumatoid arthritis while employed as a teacher for the Los Angeles Unified School District. She was awarded 37% permanent disability and future medical treatment for rheumatoid arthritis, fibromyalgia and psychiatric injuries.
On July 7, 2014, Pamela Stitt, M.D. issued a prescription for 24-hour home health care services. On August 23, 2014, defendant served applicant with a letter finding that the requested services were not medically necessary. On September 4, 2014, applicant filed a request for IMR. On November 6, 2014, Maximus Federal Services, Inc., issued a Final Determination Letter upholding the UR denial. On December 10, 2014, applicant filed an appeal of the IMR determination. December 10 was 34 days after the November 6, 2014 date of the Final Determination Letter.
The WCJ found that a five day extension for service by mail pursuant to Code of Civil Procedure [C.C.P.] section 1013(a) did not apply to applicant’s IMR appeal and issued the Findings and Order dismissing the IMR appeal as untimely. The WCAB in the case of Matute v LAUSD reversed and held that:
(1) The term “mailing” contained in section 4610.6(h) is equivalent to and means “service by mail” and (2) The 30-day period to file a timely appeal from an IMR determination under section 4610.6(h) is extended by five days pursuant to the provisions of section 5316 and C.C.P. section 1013(a).
There is no specific mention of “service” in section 4610.6(h). Thus, the issue presented is whether the “mailing” of the written IMR determination to the employee or employer is equivalent to and means service by mail. WCAB Rule 10957.1(c) specifically mentions “service by mail” as the trigger for responding to an IMR determination. This rule reflects the intended meaning of “mailing” in light of the relevant case law. The 30-day period to file an appeal of an IMR determination pursuant to section 4610.6(h) is extended by five days pursuant to the provisions of section 5316 and C.C.P. section 1013(a).