SB 863 attempted to improve the delivery of medical benefits to applicants by mandating the use of evidence-based medicine via utilization review (UR) and independent medical review (IMR).
Given the law of unintended consequences, this has brought us to the wonderful world of expedited hearings and Dubon challenges that we now routinely face. Fortunately, recent panel decisions have provided guidance, and clarified the procedural and jurisdictional issues related to UR, IMR and objections to validity of UR denials.
In Dubon v. World Restoration Inc. (2014), the W...
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