A defendant’s decision to authorize medical care should not prevent them from submitting future requests for authorization for the same treatment to utilization review, the 2nd District Court of Appeal ruled in a new published decision that agreed with arguments made by the Law Offices of Bradford and Barthel.
The California appellate court issued a decision Monday in the case of Illinois Midwest Insurance Agency v. WCAB (Rodriguez), B344044, 11/10/25.
Louis Larres, Director of the Appellate Division for the Law Offices of Bradford and Barthel, argued the case for the defense at the 2nd District Court of Appeal. John Kamin, an equity partner at the firm, argued the case at the trial level.
The appellate court’s ruling disagreed with the Workers’ Compensation Appeals Board’s “Patterson doctrine,” which for years had barred defendants from submitting requests for medical treatment to utilization review. The doctrine, which is named after a “Significant Panel Decision” named Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910, stood for the proposition that once a defendant authorized treatment, that defendant could no longer submit future requests for that treatment to utilization review unless the defendant could prove a “change in (the applicant’s) condition.”
This doctrine effectively shifted the burden of proof onto defendants to prove that the applicant’s condition had changed, and led to WCAB proceedings where defendants would try to prove a change in condition occurred.
In disagreeing with the Patterson doctrine, the appellate justices wrote that the WCAB did not have the jurisdiction to hold such proceedings, and instead directed medical treatment disputes to the utilization review (UR) and Independent Medical Review (IMR) systems as mandated by the Labor Code.
“The statutory language is explicit and unambiguous, and this court must enforce the statute according to its terms,” the appellate court wrote. “Irrespective of the reasons why a treating physician selects a particular duration of treatment in a request for authorization, the request is subject to utilization review if the employer objects, and to independent medical review after that. Nothing in the statute prohibits an employer from seeking utilization review of subsequent requests for more of the same medical treatment.”
The justices went on to write that if one applied Patterson to any ongoing medical treatment, it could ultimately expand it to all treatment. That would contradict the UR and IMR statutes, which exist to decide medical treatment disputes.
“The WCAB did not have jurisdiction to review the utilization review determination denying Rodriguez home health care,” the appellate court wrote. “Rodriguez’s remedy was to file a request for review through independent medical review, which he did not do.”
Louis Larres, the defense attorney who argued the case at the 2nd District Court of Appeal, said that he was pleased to see the court issue a decision that focused on lawmakers’ legislative intent that underlies the utilization review statutes.
“Patterson’s standard of requiring an employer show a change of circumstances and giving medical providers a pass on issuing RFAs for previously-authorized treatment (an exception to the statutory process that does not exist in the statutory scheme) has been an unwieldy exception to what should be and is a mandatory process of utilization review,” he said. “I am pleased to see the Court agreed with our position regarding the legislative intent behind the entire UR/IMR process. That is really what carried the day here. By referencing the need for medical experts to make medical decisions relying on evidence-based treatment guidelines, the Court rightfully saw how Patterson is incongruent with that legislative intent.”
UNDERLYING PROCEEDINGS
This particular dispute arose when applicant Orlando Rodriguez’s treating physicians submitted requests for authorization of home health care in 2018. The defendant had authorized home health care multiple times. In September 2019, the treating physician submitted another request for authorization (RFA) of home health care, which defendant then submitted to UR.
UR denied authorization for home health care, and the applicant’s attorney filed for an expedited hearing. The case proceeded to trial and the trial judge relied on the Patterson case to determine that defendant could not send the RFA to UR without evidence of a change in condition. The judge determined that the defendant did not prove a change in condition.
The defendant filed a petition for reconsideration, which was granted and stayed by the WCAB. In 2025, the WCAB issued a decision upon reconsideration that affirmed the trial judge’s decision.
The defense filed a petition for writ of review with the 2nd District Court of Appeal, leading to this most recent decision.
COMMENTARY
First of all, it is important to note that the applicant’s attorney may file a petition for review with the California Supreme Court, which means that this case is probably not over yet.
Assuming the 2nd DCA’s decision stands, that would mean that defendants can resume sending new RFAs to UR, regardless of whether the defendant previously authorized care in the past.
In cases where the disputed medical treatment conflicts with the medical guidelines in the Medical Treatment Utilization Schedule, that will mean that UR is more likely to deny that unnecessary treatment. That, in turn, will save defendants significant sums of money for unnecessary care that is not backed by medical guidelines.
The decision also should reduce the number of expedited hearings and trials over medical treatment disputes. This could alleviate the already-crowded dockets of venues like the Van Nuys WCAB, where some hearings are being set 5-6 months out.
Your humble blogger can also attest that it sometimes was very difficult for defense attorneys to prove a “change in condition.” This largely is because some treating physicians seemed determined to never allow a “change in condition” to exist in the first place.
This tended to occur in cases where treating physicians in the workers’ compensations system were closely-aligned with applicant’s attorneys, and therefore had little financial incentive to change recommendations for costly medical treatment. Perhaps it is because if an applicant’s condition improves, then the cycle of endless billing stops, which serves as an incentive for treating physicians to keep on recommending the same medical treatment in perpetuity. With that being said, this old axiom comes to mind, “The workers’ compensation system is the only medical system where patients never seem to get better.”
THE 2ND DCA’S NOTE ABOUT WRIT DENIEDS
On a different note, the 2nd DCA also had a warned against the perception that “writ denieds” panel decisions were approvals of the underlying decisions. This is in reference to when a party would appeal a WCAB decision to an appellate court, and the appellate court would deny review to it via a writ without arguments or a formal opinion.
“A summary denial of a petition for judicial review of an Appeals Board ruling decides no issues and has no precedential value (citations removed),” the court wrote. “The Appeals Board incorrectly characterized a case summary of Rivota (a prior writ denied) as the decision of this appellate court ‘upholding’ the Appeals Board’s application of Patterson. No appellate court has adopted the Appeals Board’s reasoning in Patterson, and we decline to do so here.”.
Got a question about workers’ compensation defense issues? Feel free to contact John P. Kamin or Louis A. Larres. Mr. Kamin is a workers’ compensation defense attorney and equity partner at Bradford & Barthel’s Woodland Hills location, where he monitors the recent legislative affairs as the firm’s Director of the Editorial Board. Mr. Kamin previously worked as a journalist for WorkCompCentral, where he reported on work-related injuries in all 50 states. Please feel free to contact John at jkamin@bradfordbarthel.com or at (818) 654-0411.
Louis A. Larres is a partner and area managing attorney at Bradford and Barthel’s Fresno office, and the director of the firm’s Appellate Division. Please feel free to contact Louis at llarres@bradfordbarthel.com or at (559) 221-6500.
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