Discover how this ruling changes HR’s role in handling long-term workers’ comp care for employees in California
California’s top court just ruled that only medical experts – not the WCAB – can decide ongoing workers’ comp care disputes after a review denial.
On November 10, 2025, the California Court of Appeal, Second Appellate District, Division Three, issued its decision in Illinois Midwest Insurance Agency LLC v. Workers’ Compensation Appeals Board and Orlando Rodriguez. The ruling clarifies that when a utilization review physician denies ongoing treatment for a workplace injury, the only way to challenge that denial is through independent medical review – not through the Workers’ Compensation Appeals Board (WCAB).
The case began after Orlando Rodriguez, a mechanic for Managed Mobile, Inc., suffered significant head and brain injuries in November 2016. The employer’s insurer, Procentury Insurance Company, administered by Illinois Midwest Insurance Agency, admitted the injuries were industrial and work-related. Starting in September 2018, Rodriguez’s primary treating physician, Dr. Yong Lee, requested home health care services in six-week increments.
Illinois Midwest approved several of these requests, sometimes after sending them to utilization review – a process in which medical professionals determine the medical necessity of requested treatment. In September 2019, Dr. Lee’s request for continued home health care was denied by a utilization review physician. Rodriguez...
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