CA DWC Ignores IBR Law That Protects Doctors
California’s Division of Workers’ Compensation (CA DWC) is violating state law daily by failing to timely assign payment disputes to Independent Bill Review (IBR).
Maximus Federal Services, Inc. conducts IBR on the CA DWC’s behalf. California law mandates that when a provider requests IBR, the CA DWC must assign the dispute to Maximus within 30 days. Maximus then has 60 days to render a decision.
So, by law, providers should wait no more than 90 days from the date they submit an IBR request to receive a final determination.
Yet, data from daisyCollect show that the CA DWC consistently violates the 30-day assignment deadline, derailing the process and leaving IBR requests to languish in limbo for months.
- As of this writing, the oldest IBR dispute that the CA DWC has failed to assign to Maximus dates back 157 days.
- Another dispute, which the CA DWC assigned but Maximus has not yet resolved, was made in December 2024—167 days ago. The CA DWC took 154 days to assign that dispute to Maximus.
For these violations, the CA DWC faces no penalty or consequence.
However, if a provider misses the deadline to request IBR by a single day, the CA DWC declares the dispute “ineligible” for IBR, and the claims administrator keeps any money they likely improperly withheld.
Below, see data on 130 IBR requests from daisyCollect, all of which the CA DWC failed to assign timely.
CA Law: Mandatory for Providers, Optional for the CA DWC
When a claims administrator pays a provider incorrectly, the provider must first submit a Second Review appeal. Under California Labor Code Section 4603.6, once the provider receives the final Explanation of Review (EOR) in response to the Second Review appeal, the provider must:
- Assemble a sizable packet of documentation
- Pay a $195 IBR filing fee
- Request IBR within 30 days of receiving the final EOR
If the provider misses the 30-day window to request IBR, fails to include the required documents in their IBR request, or fails to pay the filing fee, it’s game over—the CA DWC dismisses the case and the claims administrator keeps whatever reimbursement amount they withheld.
However, §4603.6 also mandates that:
- The CA DWC must assign the dispute to Maximus within 30 days of receiving the IBR request.
- Maximus must complete IBR and issue a decision within 60 days of the assignment.
In total, §4603.6 gives the state 90 days to resolve payment disputes through IBR. Yet, the CA DWC routinely fails to meet the assignment deadline—and in the vast majority of cases, that means the CA DWC is effectively delaying rightful payment, as providers usually win at IBR.
From February 2018 and March 2025, daisyCollect requested IBR 674 times. Maximus ruled in favor of the provider in 595 of them, or 88% of the time (statewide, providers won 82% of IBR disputes in Q1 2025).
Claims administrators often improperly deny or adjust payment—but the CA DWC has an undeniable habit of delaying justice, leaving providers without proper pay for absurd lengths of time.
The Latest Data: 130 Disputes in Limbo
daisyCollect data reveals the extent of the CA DWC’s failure. Maximus has yet to render a decision for the 130 daisyCollect IBR requests listed below. Of those:
- The CA DWC exceeded the 30-day time limit to assign all 130 disputes.
- As of this writing, the CA DWC still hasn’t assigned 96 of these disputes.
- The oldest unassigned dispute is from 157 days ago.
- The quickest the CA DWC assigned a dispute was 39 days.
- The slowest the CA DWC assigned a dispute was 154 days.
Each of these delays constitutes a violation of state law.
Collectively, these 130 pending IBR disputes represent $25,335 in filing fees that daisyCollect will likely have to fight tooth and nail to recover, since the CA DWC does not enforce the requirement to reimburse the fees when a provider prevails at IBR.
Once again, California laws are optional for everyone but providers.
By failing to follow and uphold the law regarding IBR, the CA DWC creates needless, excessive obstacles to correct reimbursement. Ultimately, injured workers and their employers pay the price as providers continue to flee this toxic system.
Claims Administrator |
Employer |
Reimbursement Amount Disputed |
IBR File Date |
IBR Assignment Date |
Days Elapsed: IBR Filed to Assignment Date |
Days Elapsed: IBR Filed to Current Date |
Employers Compensation Insurance Company |
KZ Kitchen Cabinet & Stone, Inc. |
$1,419.67 |
12/31/2024 |
06/03/2025 |
154 |
167 |
Sedgwick Claims Management Services |
Command Logistic Services Inc |
$330.91 |
01/06/2025 |
05/02/2025 |
116 |
161 |
Sedgwick Claims Management Services |
Los Angeles Unified School District |
$209.06 |
01/06/2025 |
05/01/2025 |
115 |
161 |
Employers Compensation Insurance Company |
Proyecto Diaz, LLC |
$347.41 |
01/10/2025 |
Not Assigned |
Not Assigned |
157 |
Insurance Company of the West |
Almario Espiritu Corporation |
$1,419.67 |
01/17/2025 |
05/15/2025 |
118 |
150 |
Sedgwick Claims Management Services |
Bank of America |
$404.69 |
01/17/2025 |
05/15/2025 |
118 |
150 |
Liberty Mutual Insurance |
Diagnostic Biostems |
$1,419.67 |
01/17/2025 |
05/21/2025 |
124 |
150 |
State Compensation Insurance Fund |
Giffords Backhoe Services ,Inc. |
$381.90 |
01/17/2025 |
05/20/2025 |
123 |
150 |
Employers Compensation Insurance Company |
Woody's Drapery Service Inc |
$404.69 |
01/17/2025 |
06/06/2025 |
140 |
150 |
Athens Administrators |
Artcad Builders Inc |
$443.07 |
01/28/2025 |
05/27/2025 |
119 |
139 |
Gallagher Bassett |
Entertainment Partners |
$206.28 |
01/28/2025 |
05/27/2025 |
119 |
139 |
Liberty Mutual Insurance |
UPS |
$2,298.24 |
01/28/2025 |
06/04/2025 |
127 |
139 |
Liberty Mutual Insurance |
UPS |
$398.58 |
01/28/2025 |
05/27/2025 |
119 |
139 |
AmTrust North America |
Staynet Enterprises, LLC |
$308.12 |
01/30/2025 |
06/03/2025 |
124 |
137 |
Sedgwick Claims Management Services |
Stone Master Marble & Granite Inc. |
$398.58 |
02/06/2025 |
06/13/2025 |
127 |
130 |
Sedgwick Claims Management Services |
Command Logistic Services Inc |
$330.91 |
02/07/2025 |
06/13/2025 |
126 |
129 |
State Compensation Insurance Fund |
Employment Development Department |
$382.35 |
02/07/2025 |
06/03/2025 |
116 |
129 |
Guard Insurance Group |
Gozo, LLC |
$1,419.67 |
02/07/2025 |
06/13/2025 |
126 |
129 |
Sedgwick Claims Management Services |
Northrop Grumman Corporation |
$209.06 |
02/07/2025 |
06/13/2025 |
126 |
129 |
Sedgwick Claims Management Services |
SAS Overhead-GenOPs-Kroger-Food 4 |
$209.06 |
02/07/2025 |
06/09/2025 |
122 |
129 |
Liberty Mutual Insurance |
Diagnostic Biostems |
$404.69 |
02/14/2025 |
Not Assigned |
Not Assigned |
122 |
Gallagher Bassett |
Entertainment Partners |
$308.12 |
02/14/2025 |
Not Assigned |
Not Assigned |
122 |
ESIS, Inc. |
Charter Communications |
$209.06 |
02/15/2025 |
Not Assigned |
Not Assigned |
121 |
Pacific Claims Management |
Los Angeles Jewish Home |
$2,015.00 |
02/15/2025 |
Not Assigned |
Not Assigned |
121 |
Athens Administrators |
Artcad Builders Inc |
$367.66 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Sedgwick Claims Management Services |
AT&T Services, Inc |
$209.06 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
State Compensation Insurance Fund |
California State Prison |
$206.28 |
02/21/2025 |
06/05/2025 |
104 |
115 |
Adminsure, Inc. |
City of Glendale |
$500.00 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Sedgwick Claims Management Services |
City of Los Angeles |
$1,909.47 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Gallagher Bassett |
Coast Personnel Services |
$250.00 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Sedgwick Claims Management Services |
Kaiser Foundation Hospitals |
$398.58 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Zurich Insurance North America |
OLS Hotels & Resorts |
$1,419.67 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Gallagher Bassett |
RTE Enterprises |
$219.14 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Sedgwick Claims Management Services |
SAS Overhead-GenOPs-Kroger-Food 4 |
$219.14 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Helmsman Management Services |
Sundial Industries, Inc |
$431.85 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Helmsman Management Services |
Sundial Industries, Inc |
$284.69 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Sedgwick Claims Management Services |
Walmart |
$1,419.67 |
02/21/2025 |
Not Assigned |
Not Assigned |
115 |
Gallagher Bassett |
American Medical Response |
$308.12 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
Gallagher Bassett |
C.A. Rasmussen Inc. |
$248.01 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
City of Los Angeles |
City of Los Angeles |
$161.80 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
Sedgwick Claims Management Services |
CSC Auto Salvage and Dismantling, Inc |
$398.58 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
AmTrust North America |
Esperanza Community Housing |
$284.69 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
Sedgwick Claims Management Services |
Express Services, Inc. |
$308.12 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
Gallagher Bassett |
Inn of the Seventh Ray |
$219.14 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
AmTrust North America |
Staynet Enterprises, LLC |
$308.12 |
02/27/2025 |
Not Assigned |
Not Assigned |
109 |
Sedgwick Claims Management Services |
Express Services, Inc. |
$284.69 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Liberty Mutual Insurance |
Glenair, Inc. |
$3,434.78 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Sedgwick Claims Management Services |
Los Angeles Unified School District |
$2,138.80 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Sedgwick Claims Management Services |
Northrop Grumman Corporation |
$308.12 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Gallagher Bassett |
RTE Enterprises |
$219.14 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Helmsman Management Services |
Sundial Industries, Inc |
$284.69 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Sedgwick Claims Management Services |
WKS Restaurant Corporation |
$219.14 |
03/05/2025 |
Not Assigned |
Not Assigned |
103 |
Insurance Company of the West |
Landscape Development, Inc. |
$294.32 |
03/06/2025 |
Not Assigned |
Not Assigned |
102 |
Insurance Company of the West |
Landscape Development, Inc. |
$294.32 |
03/06/2025 |
Not Assigned |
Not Assigned |
102 |
Insurance Company of the West |
Landscape Development, Inc. |
$675.93 |
03/06/2025 |
Not Assigned |
Not Assigned |
102 |
Insurance Company of the West |
Landscape Development, Inc. |
$308.12 |
03/06/2025 |
Not Assigned |
Not Assigned |
102 |
The Hartford |
Amerivet Partners Management Inc. |
$398.58 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
Employers Compensation Insurance Company |
Nulinx International Inc. |
$308.12 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
AmTrust North America |
OM Foods Hollywood, Inc. |
$431.85 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
Nationwide Insurance Companies |
PGLO Logistics Inc |
$206.28 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
Gallagher Bassett |
Price Transfer Inc |
$3,434.78 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
CNA Insurance |
Saalex Corp |
$209.06 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
CNA Insurance |
Saalex Corp |
$294.32 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
ESIS, Inc. |
Sears Holdings |
$284.69 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
ESIS, Inc. |
Shack Plumbing |
$219.14 |
03/07/2025 |
Not Assigned |
Not Assigned |
101 |
Liberty Mutual Insurance |
Amazon |
$398.58 |
03/14/2025 |
Not Assigned |
Not Assigned |
94 |
Helmsman Management Services |
BFD Warehouse, Inc |
$3,316.29 |
03/14/2025 |
Not Assigned |
Not Assigned |
94 |
Gallagher Bassett |
Entertainment Partners |
$308.12 |
03/14/2025 |
Not Assigned |
Not Assigned |
94 |
AmTrust North America |
Staynet Enterprises, LLC |
$308.12 |
03/14/2025 |
Not Assigned |
Not Assigned |
94 |
Sedgwick Claims Management Services |
County of Los Angeles |
$182.20 |
03/20/2025 |
04/28/2025 |
39 |
88 |
Sedgwick Claims Management Services |
Express Services, Inc. |
$284.69 |
03/20/2025 |
Not Assigned |
Not Assigned |
88 |
Sedgwick Claims Management Services |
Express Services, Inc. |
$206.28 |
03/20/2025 |
Not Assigned |
Not Assigned |
88 |
Helmsman Management Services |
Los Angeles Homeless Services |
$382.35 |
03/20/2025 |
Not Assigned |
Not Assigned |
88 |
Constitution State Services LLC |
Unified Grocers, Inc. |
$877.50 |
03/20/2025 |
Not Assigned |
Not Assigned |
88 |
Gallagher Bassett |
American Medical Response |
$308.12 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Athens Administrators |
Antelope Valley Hospital |
$209.06 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Athens Administrators |
Artcad Builders Inc |
$367.66 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Gallagher Bassett |
Groman Eden Mortuary |
$431.85 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Gallagher Bassett |
Robert Half Inc. |
$219.14 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Gallagher Bassett |
United Site Services |
$454.64 |
03/21/2025 |
Not Assigned |
Not Assigned |
87 |
Sedgwick Claims Management Services |
County of Los Angeles |
$524.16 |
03/28/2025 |
Not Assigned |
Not Assigned |
80 |
The Hartford |
Amerivet Partners Management Inc. |
$294.32 |
04/07/2025 |
Not Assigned |
Not Assigned |
70 |
Gallagher Bassett |
Crenshaw Enterprises, Inc |
$733.10 |
04/07/2025 |
Not Assigned |
Not Assigned |
70 |
Gallagher Bassett |
Entertainment Partners |
$208.86 |
04/07/2025 |
Not Assigned |
Not Assigned |
70 |
Sedgwick Claims Management Services |
Full Scale Logistics LLC |
$206.28 |
04/07/2025 |
Not Assigned |
Not Assigned |
70 |
Liberty Mutual Insurance |
UPS |
$284.69 |
04/07/2025 |
Not Assigned |
Not Assigned |
70 |
Gallagher Bassett |
American Medical Response |
$195.31 |
04/14/2025 |
Not Assigned |
Not Assigned |
63 |
Gallagher Bassett |
American Medical Response |
$311.28 |
04/14/2025 |
Not Assigned |
Not Assigned |
63 |
Keenan & Associates |
Antelope Valley Community College District |
$206.28 |
04/14/2025 |
05/29/2025 |
45 |
63 |
Adminsure, Inc. |
Antelope Valley Union High School District |
$256.95 |
04/14/2025 |
05/29/2025 |
45 |
63 |
JT2 Integrated Resources |
City of Oakland |
$1,419.67 |
04/14/2025 |
Not Assigned |
Not Assigned |
63 |
State Compensation Insurance Fund |
DMV |
$80.90 |
04/14/2025 |
05/29/2025 |
45 |
63 |
AmTrust North America |
First Rate Staffing Corporation |
$102.55 |
04/14/2025 |
05/30/2025 |
46 |
63 |
Sedgwick Claims Management Services |
Glendale Unified School District |
$173.72 |
04/14/2025 |
05/28/2025 |
44 |
63 |
Sedgwick Claims Management Services |
Montague Charter Academy |
$242.86 |
04/14/2025 |
05/29/2025 |
45 |
63 |
State Compensation Insurance Fund |
Napa State Hospital |
$521.21 |
04/14/2025 |
05/30/2025 |
46 |
63 |
CorVel |
Partners Personnel Management |
$121.94 |
04/14/2025 |
Not Assigned |
Not Assigned |
63 |
Helmsman Management Services |
Petco Health and Wellness Comp. |
$1,419.67 |
04/14/2025 |
Not Assigned |
Not Assigned |
63 |
Sedgwick Claims Management Services |
Santa Clarita Valley Food Service |
$242.86 |
04/14/2025 |
05/28/2025 |
44 |
63 |
Athens Administrators |
AHMC Healthcare, Inc |
$403.50 |
04/15/2025 |
06/02/2025 |
48 |
62 |
Zurich Insurance North America |
Alliance Environmental Holdings, LLC |
$213.43 |
04/25/2025 |
06/13/2025 |
49 |
52 |
Gallagher Bassett |
American Medical Response |
$108.85 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
Gallagher Bassett |
Entertainment Partners |
$152.53 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
Zurich Insurance North America |
Nobu Restaurant Group Holding Company |
$152.53 |
04/25/2025 |
06/12/2025 |
48 |
52 |
AmTrust North America |
OM Foods Hollywood, Inc. |
$311.28 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
AmTrust North America |
OM Foods Hollywood, Inc. |
$308.12 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
AmTrust North America |
OM Foods Hollywood, Inc. |
$308.12 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
Zurich Insurance North America |
Spears Manufacturing Co., Inc. |
$152.53 |
04/25/2025 |
06/12/2025 |
48 |
52 |
Zurich Insurance North America |
Tutor Perini Corporation |
$213.43 |
04/25/2025 |
06/12/2025 |
48 |
52 |
Gallagher Bassett |
United Site Services |
$459.17 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
Sedgwick Claims Management Services |
Walmart |
$89.87 |
04/25/2025 |
Not Assigned |
Not Assigned |
52 |
Keenan & Associates |
Antelope Valley Schools Transportation Agency |
$242.07 |
05/01/2025 |
Not Assigned |
Not Assigned |
46 |
WCF Insurance |
Cordelia RV |
$301.55 |
05/01/2025 |
Not Assigned |
Not Assigned |
46 |
Gallagher Bassett |
Entertainment Partners |
$152.53 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Entertainment Partners |
$213.43 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Sedgwick Claims Management Services |
Express Services, Inc. |
$288.17 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Gilcrest Properties, LLC |
$213.43 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Holliday Rock Co., Inc. |
$208.86 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Guard Insurance Group |
Ray Cox Air Conditioning, Inc. |
$102.55 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Rowland Air |
$208.86 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Sodexo, Inc. |
$311.28 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
TA Operating LLC |
$213.43 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
The Habit Burger Grill |
$213.43 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Gallagher Bassett |
Today's Hotel Corporation |
$1,737.93 |
05/06/2025 |
Not Assigned |
Not Assigned |
41 |
Zurich Insurance North America |
Centre for Neuro Skills |
$213.43 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
Zurich Insurance North America |
Clark Roofing |
$189.48 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
Zurich Insurance North America |
Clark Roofing |
$189.48 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
Farmers Insurance |
Dutra Landscape & Gardening |
$227.50 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
Zurich Insurance North America |
Red Lobster Management LLC |
$213.43 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
Zurich Insurance North America |
The TJX Companies, Inc. |
$213.43 |
05/07/2025 |
Not Assigned |
Not Assigned |
40 |
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