MICHAEL SULLIVAN & ASSOCIATES BLOG

In an important development, the well-known Patterson case has been reversed by a Court of Appeal. Patterson is the significant panel decision that held that certain types of continuing care were not subject to utilization review (UR) and independent medical review (IMR). This decision, Illinois Midwest Insurance Agency LLC v. WCAB (Rodriguez) has held that the Patterson reasoning was inapposite of the statutory language, and has subjected continuing care to UR/IMR.

BACKGROUND

With the enactment of Senate Bill 863 in 2012, the California Legislature established the independent medical review (IMR) process. It became effective for all treatment requests Jan. 1, 2013. The IMR process replaced judicial review as the method to appeal UR decisions regarding all proposed medical care. Under the statutory scheme, all proposed medical care is to be requested by a physician submitting a request for authorization (RFA). That request is reviewed by UR, and may be appealed only to IMR. Judicial review of such care for reasonableness was no longer allowed (later case law established the sole exception — being for late UR).

California Senate Bill 487, signed into law in 2025, brings significant changes to the way employers and insurers can recover costs in workers’ compensation cases involving peace officers. The new law, heavily opposed by the employer community, places strict limits on subrogation recovery and eliminates a long-standing credit right that has been a cornerstone of cost control in public safety claims.

These changes will have a substantial impact on counties, cities, and other public entities that handle workers’ compensation claims for law enforcement officers.

October was full of energy, connection, and celebration for the MS&A team! From honoring leaders in our legal community to engaging with HR and workers’ comp professionals across California, our Rhinos were out in full force. We also made time for some team-building fun — strengthening the bonds that make our firm thrive.

Scroll through the snapshots below to see how our teams came together to connect, contribute, and celebrate along the way.

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California Code of Regulations, Title 8, § 30 establishes the process by which a party may request a panel of qualified medical evaluators (QMEs) from the DWC Medical Unit. CCR 30(b) applies when an employee is represented by an attorney. It requires a party requesting a panel to provide specified information, including the claim number.

Previously, the Workers’ Compensation Appeals Board (WCAB) has been inconsistent as to whether a party's failure to provide the correct claim number renders a panel request invalid. In Sidahmed v. Alameda County Counsel, 2024 Cal. Wrk. Comp. P.D. LEXIS 103, the WCAB held that a defendant's failure to provide the correct claim number rendered its request for the issuance of a panel of QMEs void ab initio. But later, it held in Salamat v. SBM Site Services, 2025 Cal. Wrk. Comp. P.D. LEXIS 28, that an applicant's request for a panel was not invalid, even though she mistakenly listed a specific injury claim number on the panel request rather than the intended cumulative injury claim number, stating, "To find otherwise would place form over substance."

For more than two decades, the law governing the identification of liable parties has been shaped by the Workers' Compensation Appeals Board’s en banc decisions in Coldiron v. Compuware Corp. In Coldiron I,^[1] the WCAB held that a third-party administrator (TPA) has a duty to disclose the identity of its client — whether a self-insured employer or an insurance carrier. Crucially, if the client is an insurance carrier, the TPA also must disclose whether the policy includes a "high self-insured retention," a large deductible or any other provision that affects the identity of the entity ultimately liable for payment. The WCAB warned that failure to do so could result in sanctions.

In Coldiron II,^[2] the WCAB declined to impose sanctions, as it was a case of first impression, but reiterated that the disclosure holdings remained in full force and effect.

From Monterey to San Diego, the MS&A team stayed on the move this September—connecting with colleagues and clients at industry conferences, training events, and celebrations across the state. Whether sharing insights at CAJPA, joining partners for professional development, or raising a glass with friends of the firm, we’re proud to be part of such a dynamic and collaborative community.

The relationships and ideas shared this month continue to inspire our work and strengthen our commitment to the industry.

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The use of sub rosa surveillance video is a powerful tool in workers' compensation, often used to challenge an applicant’s credibility regarding the claimed level of disability. The timing and procedure for providing such evidence can be a point of significant dispute.

The Workers' Compensation Appeals Board (WCAB) has long recognized that a defendant may withhold surveillance video until after an applicant's deposition. In Downing v. City of Hayward (1988) 16 CWCR 76 (panel decision), the WCAB explained:

From connecting with clients at a Lunch & Learn, to networking at the LA RIMS Summer Mixer, to joining industry partners at summer events, August was a busy and rewarding month for the MS&A team. We’re grateful for every opportunity to share knowledge, strengthen relationships, and engage with the workers’ comp and risk management community.

Looking forward to even more great moments this fall!

If you'd like to join MS&A at one of our upcoming events, just follow us on one of our social media channels--we're on LinkedIn, Instagram, and Facebook. We'd love to have you attend one of our events!