CA DWC Ignores Law and Leaves Ortho Practice Unpaid

August 19, 2025 6 min read

In California, when a provider pays $195 to request Independent Bill Review (IBR) to dispute an incorrect payment, the California Division of Workers’ Compensation (CA DWC) has an important legal obligation: to assign the dispute to Maximus (the state’s independent reviewer) within 30 days.

For some reason, the CA DWC routinely violates this statutory 30-day assignment requirement.

daisyNews recently reported how IBR records reveal that the CA DWC was late to assign 10,315 out of 16,215 IBR disputes providers filed statewide since 2018, with the “late rate” reaching 87% so far for 2025. Below, we share data from daisyCollect that show the impact the agency’s failures can have on a single practice.

As of this writing, a California orthopedic office is waiting on 62 IBR requests, all of which are beyond the 30-day deadline for the CA DWC to assign to Maximus.

The oldest dispute is currently 86 days late for assignment, for an IBR request daisyCollect filed in April.
Eight providers remain unpaid for treatment they rendered.
The practice has spent $12,090 in filing fees for the 62 IBR requests.

In all likelihood, payers owe this practice thousands in revenue, thousands in penalties and interest, and thousands in IBR filing fees. Historically, Maximus sides with practice in 90% of cases statewide. For this particular practice, Maximus awarded additional reimbursement in 94% of IBR disputes in 2024 and 2025 so far.

See the damning data on these late IBR requests below. Many systemic issues plague California’s workers’ comp system, not the least of which is the agency responsible for managing that system.

Patterns of Payment Abuse: Gallagher Bassett & Sedgwick Lead the Pack

The repeated experience of this single orthopedic practice reveals a disturbing pattern in how payers routinely abuse providers who treat injured workers, with the tacit permission of the CA DWC.

Of the 62 overdue IBR requests:

Gallagher Bassett is the payer in 38 of the disputes (61%)
Sedgwick Claims Management Services, Inc. is the payer in 11 of the disputes (18%)

Gallagher Bassett and Sedgwick are two of the largest payers in workers’ comp, and two of the most consistent beneficiaries of the CA DWC’s failure to manage IBR in accordance with the law. Again and again, we see these claims administrators play a game we call “IBR Chicken.”

Deny the original bill, often for transparently flimsy or nonsensical reasons.
Deny the provider’s Second Review appeal, often on equally baseless grounds.
If the provider pays $195, submits the paperwork, and prevails at IBR, simply pay the amount in dispute (and nothing more).

A Lose-Lose Game for CA Providers

California Labor Code Section 4603.6 mandates that when Maximus rules in the provider’s favor, the payer must restore the $195 IBR filing fee to the provider. The CA DWC does not enforce this requirement. Labor Code Section 4603.2 mandates penalties and interest, but those payments are “self-executing.”

In other words, there’s no incentive for companies like Gallagher Bassett and Sedgwick to pay doctors correctly, and every incentive to throw any denial (however baseless) at the wall and see if it sticks.

Best case scenario, the provider lacks the time, money, administrative resources, or willpower to endure the appeals gauntlet all the way to IBR, and the payer keeps every dime they owe.

Worst case, even if the provider “wins” at IBR, the payer only has to cough up exactly what they owed in the first place.

Either way, Gallagher Bassett, Sedgwick and other payers win by delaying and potentially keeping payment owed to providers who lack the resources to constantly file IBR requests.

The CA DWC excels in creating delays and obstacles in this appeals process, discouraging providers from fighting for correct reimbursement and incentivizing payment abuse. This agency:

Does nothing while payers improperly deny Second Review appeals as so-called “duplicate bills”
Deems valid payment disputes “ineligible” for IBR
Leaves IBR requests to gather dust (and interest owed) for months or longer, in violation of state law

Thanks to the CA DWC’s compliance double standard (providers who fail to timely request IBR forfeit any additional reimbursement), improper reimbursement is a financially rewarding business practice for any payer willing to play IBR Chicken.

Defenseless in the CA DWC’s effective absence, providers eat the loss on countless workers’ comp patients while payers, vendors, and their private equity backers reap the spoils.

Below are the details of our orthopedic client’s pending, egregiously late IBR requests, including:

The reimbursement amounts in dispute
The number of days the CA DWC is late in assigning the disputes to Maximus
The dates daisyCollect filed the IBR requests

With this practice “winning” at IBR 94% of the time, the data below represents serious revenue that these payers have improperly withheld, serious amounts paid in IBR fees, and the injustice the CA DWC daily enables.

IBR Case Number	Claims Administrator	Employer	Reimbursement Amount in Dispute	IBR Request Date	Assignment Due Date (30 Days after IBR Request Date)	Days Elapsed: IBR Assignment Due Date to Current Date
CB25-0001607	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	04/25/2025	05/25/2025	86
CB25-0001606	AmTrust North America	OM Foods Hollywood, Inc.	$308.12	04/25/2025	05/25/2025	86
CB25-0001605	AmTrust North America	OM Foods Hollywood, Inc.	$308.12	04/25/2025	05/25/2025	86
CB25-0001596	Gallagher Bassett	American Medical Response	$108.85	04/25/2025	05/25/2025	86
CB25-0001594	Gallagher Bassett	ENTERTAINMENT PARTNERS	$152.53	04/25/2025	05/25/2025	86
CB25-0001593	Gallagher Bassett	United Site Services	$459.17	04/25/2025	05/25/2025	86
CB25-0001740	Gallagher Bassett	Gilcrest Properties, LLC	$213.43	05/06/2025	06/05/2025	75
CB25-0001738	Gallagher Bassett	Entertainment Partners	$152.53	05/06/2025	06/05/2025	75
CB25-0001737	Gallagher Bassett	ENTERTAINMENT PARTNERS	$213.43	05/06/2025	06/05/2025	75
CB25-0001736	Gallagher Bassett	TA OPERATING	$213.43	05/06/2025	06/05/2025	75
CB25-0001734	Gallagher Bassett	Todays Hotel Corporation	$1,737.93	05/06/2025	06/05/2025	75
CB25-0001733	Gallagher Bassett	Rowland Air	$208.86	05/06/2025	06/05/2025	75
CB25-0001732	Gallagher Bassett	SODEXO SERVICES WEST LLC	$311.28	05/06/2025	06/05/2025	75
CB25-0001731	Sedgwick Claims Management Services	EXPRESS SERVICES	$288.17	05/06/2025	06/05/2025	75
CB25-0001838	Sedgwick Claims Management Services	SMART & FINAL	$212.42	05/12/2025	06/11/2025	69
CB25-0001832	Sedgwick Claims Management Services	MACY'S WEST STORES, INC	$375.00	05/12/2025	06/11/2025	69
CB25-0001831	Sedgwick Claims Management Services	LAUSD	$80.00	05/12/2025	06/11/2025	69
CB25-0001830	Gallagher Bassett	INN of the Seventh Ray	$222.15	05/12/2025	06/11/2025	69
CB25-0001829	Gallagher Bassett	ROBERT HALF INTERNATIONAL	$188.84	05/12/2025	06/11/2025	69
CB25-0001828	Sedgwick Claims Management Services	Langham Hotels Pacific Corporation	$288.17	05/12/2025	06/11/2025	69
CB25-0001827	CorVel	Barrett Business Services, Inc	$1,371.80	05/12/2025	06/11/2025	69
CB25-0001973	Helmsman Management Services	NBC UNIVERSAL, LLC	$171.23	05/21/2025	06/20/2025	60
CB25-0001972	Gallagher Bassett	Wholefoods Market	$656.00	05/21/2025	06/20/2025	60
CB25-0002013	Gallagher Bassett	ENTERTAINMENT PARTNERS	$145.91	05/27/2025	06/26/2025	54
CB25-0002035	Zurich Insurance North America	OC Forestry, Inc	$213.43	05/28/2025	06/27/2025	53
CB25-0002033	Gallagher Bassett	ENTERTAINMENT PARTNERS	$222.15	05/28/2025	06/27/2025	53
CB25-0002032	Gallagher Bassett	ENTERTAINMENT PARTNERS	$188.84	05/28/2025	06/27/2025	53
CB25-0002029	Gallagher Bassett	ACE AMERICA INS	$213.43	05/28/2025	06/27/2025	53
CB25-0002028	Gallagher Bassett	Spencer Spirit Holdings	$108.85	05/28/2025	06/27/2025	53
CB25-0002027	Gallagher Bassett	WHOLE FOODS MARKET	$1,289.36	05/28/2025	06/27/2025	53
CB25-0002025	State Compensation Insurance Fund	Wasco State Prison	$297.78	05/28/2025	06/27/2025	53
CB25-0002059	Sedgwick Claims Management Services	ABM Industries, Inc/ Able Services	$435.59	05/30/2025	06/29/2025	51
CB25-0002058	Sedgwick Claims Management Services	ABM Industries, Inc	$311.28	05/30/2025	06/29/2025	51
CB25-0002347	Gallagher Bassett	Spencer Spirit Holdings	$152.53	06/25/2025	07/25/2025	25
CB25-0002346	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	25
CB25-0002345	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	25
CB25-0002344	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	25
CB25-0002343	Gallagher Bassett	ENTERTAINMENT PARTNERS	$152.53	06/25/2025	07/25/2025	25
CB25-0002342	Gallagher Bassett	Entertainment Partners	$152.53	06/25/2025	07/25/2025	25
CB25-0002341	Gallagher Bassett	Bright Horizons	$152.53	06/25/2025	07/25/2025	25
CB25-0002336	Sedgwick Claims Management Services	YRC Inc. DBA YRC FREIGHT	$311.28	06/25/2025	07/25/2025	25
CB25-0002433	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002432	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002431	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002429	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002428	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002427	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	19
CB25-0002425	State Compensation Insurance Fund	DEPT. OF INDUSTRIAL RELATIONS	$208.86	07/01/2025	07/31/2025	19
CB25-0002453	Sedgwick Claims Management Services	LAUSD	$328.82	07/02/2025	08/01/2025	18
CB25-0002474	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	07/03/2025	08/02/2025	17
CB25-0002517	Gallagher Bassett	PHARMAVITE LLC	$211.50	07/08/2025	08/07/2025	12
CB25-0002516	Sedgwick Claims Management Services	COLA CAMMAND LOGISTICS	$311.28	07/08/2025	08/07/2025	12
CB25-0002515	Helmsman Management Services	United Rentals, Inc	$3,486.44	07/08/2025	08/07/2025	12
CB25-0002514	Gallagher Bassett	ENTERTAINMENT PARTNERS	$311.28	07/08/2025	08/07/2025	12
CB25-0002513	Gallagher Bassett	ROBERT HALF INTERNATIONAL	$188.84	07/08/2025	08/07/2025	12
CB25-0002512	Gallagher Bassett	SODEXO SERVICES WEST LLC	$311.28	07/08/2025	08/07/2025	12
CB25-0002543	Gallagher Bassett	HOLLIDAY ROCK COMPANIES DRIVER	$213.43	07/09/2025	08/08/2025	11
CB25-0002542	Gallagher Bassett	Spencer Spirit Holdings	$152.53	07/09/2025	08/08/2025	11
CB25-0002541	Zurich Insurance North America	FEDERAL CLEANING CONTRACTORS INC	$213.43	07/09/2025	08/08/2025	11
CB25-0002561	Zurich Insurance North America	TUTOR PERINI CORPORATION	$311.28	07/10/2025	08/09/2025	10
CB25-0002560	Sedgwick Claims Management Services	LAUSD	$643.31	07/10/2025	08/09/2025	10
CB25-0002559	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	07/10/2025	08/09/2025	10
		Total Reimbursement Owed	$23,173.53

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