Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 4600(a)
Section 4600 requires employer to provide reasonable medical treatment to cure or relieve effects of industrial injury.
Employer must provide reasonable medical treatment including transportation if medically necessary.
From the decision · page 6Section 4600 requires the employer to provide reasonable medical treatment to cure or
relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) Employers are required to
establish a UR process for treatment requests received from physicians. (Lab. Code, § 4610; State
Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 236.)
Lab. Code, 4610
Section 4610 requires establishment of utilization review process for treatment requests based on medical necessity.
UR process reviews treatment requests for medical necessity prior to provision of services.
From the decision · page 6Section 4600 requires the employer to provide reasonable medical treatment to cure or
relieve from the effects of an industrial injury. (Lab. Code, § 4600(a).) Employers are required to
establish a UR process for treatment requests received from physicians. (Lab. Code, § 4610; State
Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 236.)
Lab. Code, 4610.5(c)(1) and (3)
Disputes regarding utilization review decisions on medical necessity must be resolved by independent medical review (IMR).
IMR is the exclusive remedy for disputes on medical necessity of UR decisions.
From the decision · page 7by IMR." (Id. at p. 1299.) As noted in the Dubon II decision, section 4604 provides that
"[c]ontroversies between employer and employee arising under this chapter shall be determined
by the appeals board, upon the request of either party, except as otherwise provided by Section
4610.5." (Id. at p. 1305, emphasis in original.) Sections 4610 and 4610.5 expressly define a UR
decision addressing treatment "based in whole or in part on medical necessity." In Dubon II, the
Appeals Board found that sections 4610.5 and 4610.6 "specifically provide that where there is a
dispute regarding a UR decision on `medical necessity,' the dispute shall be resolved only by
IMR." (Id. at p. 1309.)
Lab. Code, 5304
Appeals Board has jurisdiction over medical treatment controversies not subject to IMR.
Appeals Board can determine medical treatment disputes not eligible for IMR.
From the decision · page 7The Legislature has implemented a process to address treatment requests through UR and
IMR. However, since both UR and IMR have declined to address the recommendation for
transportation for applicant, the Appeals Board has jurisdiction to determine whether defendant
must provide this on an industrial basis. The Labor Code expressly vests the Appeals Board with
the authority for "the enforcement against the employer or an insurer of any liability for
compensation imposed upon the employer by this division in favor of the injured employee." (Lab.
Code, § 5300(b); see also Lab. Code, § 5301, 3207 [section 3207 defines "compensation" as
"every benefit or payment conferred by this division upon an injured employee"].) The Appeals
Board retains the authority to determine medical treatment controversies not subject to IMR. (See
Lab. Code, § 5304 [the "appeals board has jurisdiction over any controversy relating or arising out
of Sections 4600 to 4605 inclusive"].) In the absence of the Appeals Board's authority to address
Avalon Bay Foods v. Workers' Comp. Appeals Bd. (Moore) (1998) 18 Cal.4th 1165
Expenses for transportation for medical treatment appointments are ancillary to medical treatment benefits under section 4600.
Transportation expenses are part of medical treatment benefits under section 4600.
Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36
Attendant services, like housekeeping, may be compensable if medically necessary and reasonable, including assistance with transportation for non-medical reasons.
Non-medical transportation assistance can be compensable if reasonable and necessary.