EDD OFFICES BEING REMOVED FROM BOARDS

EDD Public Affairs Chief Greg Lawson has confirmed that State Disability Insurance representatives have been attending workers' compensation hearings remotely, and have concluded that virtual participation is efficient and cost-effective. By the end of June, EDD will no longer be leasing offices space from the DIR resulting in the EDD offices being closed.

Addtional insights have include that EDD representatives may still be appearing in-person as required at proceedings such as lien trials. Also, EDD is working to implement a statewide call line, rather than directing calls to specific geographic offices.

[COMMENT: The system now is inefficient as parties can either wait several days, weeks or even longer for a returned call or e-mail or stand in line at the local Board for 1-2 hours to work with an EDD representative. Can only hope that a centralized statewide wide system will somehow be more efficient...but don't count on it.]

IMR ANNUAL REPORT HIGHLIGHTS



The Independent Medical Review (IMR) process was estbalished in 2013 to provide an effective resolution for medical disputes in California's workers' compensation system.

The DIR/DWC has issued its 2025 report on IMR with some interesting facts including: a) Received on average 12,736 eligible applications per month. b) They received 15,000 applications per month deemed to be ineligible for reasons that include the lack of applicant or representative signature, not being submitted within 30 days from UR decision, or the UR decision was not attached to the application. c) The average IMR response time being 6-7 days upon receipt of all medicals.d) Overturned 10.2% of utilization review (UR) decisions, which was down from 12.7% in 2024.

Additionally, some common trends included: a) Most UR overturned decisions by drug type were antidepressants (24.1%), NSAIDS (18.9%) and anti-ulcer agents (18.3%); b) Skeletal muscle relaxants (e.g. Baclofen, Flexeril,Tizanidine) were rarely overturned (1%) on appeal; and c) The most overturned type of treatment services requested were Behavioral & Mental Services (20% of denials were overturned).

[COMMENT: Important to note that almost 90% of all UR decisions are upheld on appeal.]



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UPDATED REGULATIONS RE: RFA

The DWC has issued a Newsline Release confirming that the DWC approved "RFA Form" is the mandatory standard pertaining to formal requests for medical treatment authorization pursuant to 8 CCR 9792.6.

The DWC has also clarified that a narrative report may serve in the same capacity as a RFA, but under the limited conditions which include: 1) That the claims administrator is willing to voluntarily accept the report instead of an RFA; and 2) The report must satisfy the minimum content standard of an RFA, accompanied by supporting medical documentation, and be signed by the treating physician.

[COMMENT: Assume most claims personnel would prefer the short and concise RFA as oppose to sifting through a medical report for a RFA equivalent.]

HEWS NEWS

June 2026 Work Anniversaries: Shareholders/Attorneys Michelle Waters (26 years) and Brandon R. Lewis (22 years); as well as legal assistants Livni Galvan (2 years), Kauthar Alaghbar (2 years), Isabella Hernandez (1 year) and Cynthia Bustamente (1 year).

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Main Contributor: H. Neal Wells IV hnw@hmplc.com

Editorial Staff: Lynn P. Peterson

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The above is for informational purposes only, and not intended to constitute legal advice.