Cal. Code Regs. Tit. 8, § 10567 - Petition Appealing Independent Bill Review Determination

(a) An aggrieved party may file a petition appealing an independent bill review (IBR) determination of the Administrative Director (AD). For purposes of this section, a "determination" includes a decision regarding the amount payable to the provider, if any, and/or a decision that a dispute is not subject to independent bill review.

(b) The petition shall comply with each of the following provisions:

(1) The petition shall be limited to raising one or more of the five grounds specified in Labor Code section 4603.6(f).

(2) The petition shall set forth specifically and in full detail the factual and/or legal grounds upon which the petitioner considers the IBR determination to be unjust or unlawful, and every issue to be considered by the Workers' Compensation Appeals Board. The petitioner shall be deemed to have finally waived all objections, irregularities, and illegalities concerning the IBR determination other than those set forth in the petition appealing.

(c) The petition shall be filed in accordance with rule 10615 no later than 20 days after service of the IBR determination.

(d) In addition to service as required by rule 10625, the petition and any additional documents or pleadings related to the petition shall be served on the IBR Unit in accordance with rule 10632.

(e) The petition shall be captioned "Petition Appealing Administrative Director's Independent Bill Review Determination" and shall include the assigned ADJ number and the IBR case number assigned by the Administrative director.

(f) The petition shall include a copy of the IBR determination and proof of service of that determination.

(g) Upon receiving notice of the petition, the IBR Unit may download the record of the independent bill review organization into EAMS, in whole or in part. The Workers' Compensation Appeals Board, in its discretion, may:

(1) Admit all or any part of the downloaded IBR record into evidence; and/or

(2) Permit the parties to offer in evidence documents that are duplicates of ones already existing in the downloaded IBR record.

(h) The petition shall not be placed on calendar unless a Declaration of Readiness to Proceed is filed and served on the Administrative Director, all adverse parties and the applicant.

(i) If the IBR determination is not affirmed by the workers' compensation judge or the Appeals Board, it shall be rescinded and the dispute returned to the Administrative Director with an order specifying the basis for the rescission, and an order to resubmit the dispute to IBR in accordance with Labor Code section 4603.6(g).

(j) If a final decision of the Workers' Compensation Appeals Board affirms the Administrative Director's IBR determination and results in the defendant being liable for any payment to the provider, the amount for which the defendant is liable shall be paid to the provider forthwith. If the defendant fails to pay forthwith, the provider need not file a lien claim and may file a petition to enforce under rule 10570.

Notes

Cal. Code Regs. Tit. 8, § 10567

1. Renumbering of former section 10957 to section 10567, including amendment of section heading, section and NOTE, filed 12-17-2019; operative 1-1-2020. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2019, No. 51).

Note: Authority cited: Sections 133, 5307, 5309 and 5708, Labor Code. Reference: Sections 4603.6, 5500, 5501, 5502, 5700 et seq., 5800 et seq. and 5900 et seq., Labor Code.

1. Renumbering of former section 10957 to section 10567, including amendment of section heading, section and Note, filed 12-17-2019; operative 1-1-2020. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2019, No. 51).