Angelique Diaz sustained injury to her bilateral upper extremities, psyche, and in the form of hypertension while working for the Southern California Gas Company.
On July 11, 2017, the UR physician denied a treatment request for an EMG, which was overturned by a MAXIMUS IMR Final Determination Letter dated September 12, 2017.
On October, 2, 2017, the UR physician denied a treatment request for Norco, which was overturned by a MAXIMUS IMR Final Determination Letter dated November 8, 2017.
On January 24, 2018, the UR. physician denied a treatment request for Norco and chiropractic treatment, which was overturned by a MAXIMUS IMR Final Determination Letter dated March 26, 2018.
On March 15, 2018, the UR physician denied a treatment request for bilateral upper extremity nerve conduction studies, which was overturned by a MAXIMUS IMR Final Determination Letter dated April 24, 2018.
Applicant’s attorney filed a petition for LC5814 penalties for the four UR denials that IMR overturned. The issues went to trial and the WCJ found that the UR doctors had used inappropriate guidelines.
The WCJ found that there was no wrongdoing by the defendant employer/carrier and that the UR doctors are not agents of the defendant and are not parties. Thus, there is no LC5 814 penalty.
The applicant’s petition for reconsideration was denied in the panel decision of Diaz v Southern California Gas Company.
Labor Code section 4610.1 provides as relevant herein: An employee shall not be entitled to an increase in compensation under Section 5814 for unreasonable delay in the provision of medical treatment for periods of time necessary to complete the utilization review process in compliance with Section 4610. (§ 4610.1 )
The WCAB panel agreed with the WCJ that, since applicant argues that she is entitled to penalties for delay that occurred while the utilization review was in the process of completion-i.e., while the UR physicians failed to properly address the requests of her treating physician-applicant is barred by section 4610.1 from recovering section 5814 penalties.
Accordingly, it concluded that the WCJ correctly determined that defendant is not liable for section 5 814 penalties based upon alleged delay occurring during the UR process.