CA DWC Ignores IBR Law, Leaves Practice Short $75K+

November 3, 2025 8 min read

Independent Bill Review (IBR) is supposed to protect California providers when payers refuse to correctly reimburse for injured workers’ treatment.

Yet the California Division of Workers’ Compensation (CA DWC) routinely impedes this legal safeguard by delaying IBR, in clear defiance of state law.

When payers fail to reimburse correctly and deny subsequent appeals, the provider’s last resort is to pay $195 to request IBR. Tellingly, Maximus Federal Services (the state’s designated reviewer) rules in the provider’s favor in the vast majority of IBR disputes, indicating that IBR is a crucial tool for correcting improper denials and reductions.

California law requires the CA DWC to assign disputes to Maximus within 30 days of the provider filing the IBR request. Yet, as daisyNews has exposed, the CA DWC routinely flouts this legal obligation and knowingly misses its IBR deadline, depriving providers of due process as guaranteed by state law.

As of this writing, a single daisyCollect practice has 108 pending IBR cases, all of which the CA DWC failed to assign on time. Several have languished unresolved since we last reported on the CA DWC’s negligence months ago.

The oldest IBR dispute is currently 131 days overdue, from a request daisyCollect filed in June.
Assuming Maximus rules in the practice’s favor (and that’s a wise assumption given past decisions), payers owe this practice $54,446.03 in unpaid reimbursement.
To obtain reimbursement owed per California law, the practice has paid $21,060 in IBR filing fees.

Altogether, this practice is out $75,506.03 while the CA DWC shirks its legal duties.

Somehow, providers continue to treat California’s injured workers despite the challenges of doing business in a state with an absentee regulator. How long can they afford this payment (and regulatory) abuse?

Worst Offenders: Gallagher Bassett, Sedgwick, Southern CA Edison

With the CA DWC consistently abdicating its duty to uphold workers’ comp laws and regulations (including laws that apply to the agency itself), payers enjoy a consequence-free environment where the state effectively incentivizes non-compliance.

Payers are reaping the benefits of the CA DWC’s inaction. Of this practice’s 108 overdue IBR requests:

Gallagher Bassett is the payer in 29 of the disputes (27%)
Southern California Edison is the payer in 27 of the disputes (25%)
Sedgwick Claims Management Services, Inc. is the payer in 13 of the disputes (12%)

In California, the payers above, and others, routinely play "IBR Chicken” to effectively dodge payment. The game works as follows:

Deny the original bill (often for transparently bogus reasons).
Deny the provider’s Second Review appeal (often on equally baseless grounds).
If the provider manages to pay $195 and wins at IBR, simply pay the amount in dispute (and nothing more).

If the provider can’t manage the appeals gauntlet, the payer keeps the money by default. If the provider makes it to IBR and wins, the payer can just…pay what they would’ve owed anyway. It’s a perfect recipe for abuse.

CA DWC Stacks the Deck Against Providers

California Labor Code Section 4603.6 instructs that when Maximus overturns a payer’s incorrect payment, the payer must restore the $195 IBR filing fee to the provider. Labor Code Section 4603.2 imposes penalties and interest for failure to pay the correct amount on time.

However, the CA DWC does not enforce either requirement.

Payers consistently decline to reimburse providers for the IBR filing fee and fail to pay penalties and interest payments which are (sigh) “self-executing.” So why would any payer take pains to reimburse correctly?

CA DWC: An Impediment to Justice

Note that providers who fail to request IBR within 30 days of receiving the final Explanation of Review from the payer forfeit any additional reimbursement.

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

The reimbursement amounts in dispute
The date of the deadline by which the CA DWC was legally bound to assign the dispute to IBR
The number of days that have passed since the due date for the CA DWC to assign the dispute

Bear in mind that Maximus has ruled in favor of this practice in 94% of the disputes the CA DWC finally got around to assigning for IBR. Moreover, according to CA DWC data, Maximus ruled in favor of providers in 83% of all IBR cases that providers filed in 2024.

In other words, payers almost certainly owe the money in dispute below to this practice, and Maximus will likely rule accordingly. The only obstacle is the eternally useless CA DWC.

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
CB25-0002347	Gallagher Bassett	Spencer Spirit Holdings	$152.53	06/25/2025	07/25/2025	131
CB25-0002346	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	131
CB25-0002345	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	131
CB25-0002344	Gallagher Bassett	CPI HOLDCO LLC	$145.91	06/25/2025	07/25/2025	131
CB25-0002343	Gallagher Bassett	ENTERTAINMENT PARTNERS	$152.53	06/25/2025	07/25/2025	131
CB25-0002341	Gallagher Bassett	Bright Horizons	$152.53	06/25/2025	07/25/2025	131
CB25-0002336	Sedgwick Claims Management Services	YRC Inc. DBA YRC FREIGHT	$311.28	06/25/2025	07/25/2025	131
CB25-0002433	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002432	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002431	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002429	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002428	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002427	Gallagher Bassett	GALLAGHER BASSETT	$386.70	07/01/2025	07/31/2025	125
CB25-0002453	Sedgwick Claims Management Services	LAUSD	$328.82	07/02/2025	08/01/2025	124
CB25-0002474	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	07/03/2025	08/02/2025	123
CB25-0002516	Sedgwick Claims Management Services	COLA CAMMAND LOGISTICS	$311.28	07/08/2025	08/07/2025	118
CB25-0002515	Helmsman Management Services	United Rentals, Inc	$3,486.44	07/08/2025	08/07/2025	118
CB25-0002514	Gallagher Bassett	ENTERTAINMENT PARTNERS	$311.28	07/08/2025	08/07/2025	118
CB25-0002513	Gallagher Bassett	ROBERT HALF INTERNATIONAL	$188.84	07/08/2025	08/07/2025	118
CB25-0002512	Gallagher Bassett	SODEXO SERVICES WEST LLC	$311.28	07/08/2025	08/07/2025	118
CB25-0002543	Gallagher Bassett	HOLLIDAY ROCK COMPANIES DRIVER	$213.43	07/09/2025	08/08/2025	117
CB25-0002542	Gallagher Bassett	Spencer Spirit Holdings	$152.53	07/09/2025	08/08/2025	117
CB25-0002541	Zurich Insurance North America	FEDERAL CLEANING CONTRACTORS INC	$213.43	07/09/2025	08/08/2025	117
CB25-0002561	Zurich Insurance North America	TUTOR PERINI CORPORATION	$311.28	07/10/2025	08/09/2025	116
CB25-0002560	Sedgwick Claims Management Services	LAUSD	$643.31	07/10/2025	08/09/2025	116
CB25-0002559	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	07/10/2025	08/09/2025	116
CB25-0002701	Gallagher Bassett	ROBERT HALF INTERNATIONAL	$108.85	07/23/2025	08/22/2025	103
CB25-0002699	Gallagher Bassett	Entertainment Partners	$287.52	07/23/2025	08/22/2025	103
CB25-0002727	Sedgwick Claims Management Services	ABM Industries, Inc/ Able Services	$435.59	07/24/2025	08/23/2025	102
CB25-0002804	AmTrust North America	Canoga Park Fitness, LLC	$212.42	07/31/2025	08/30/2025	95
CB25-0002801	Berkshire Hathaway Homestate Companies	UNIVERSAL ELECTRONIC ALARMS	$6,793.93	07/31/2025	08/30/2025	95
CB25-0002901	Berkshire Hathaway Homestate Companies	Gordon Special Services	$435.59	08/08/2025	09/07/2025	87
CB25-0002894	Gallagher Bassett	Entertainment Partners	$311.28	08/08/2025	09/07/2025	87
CB25-0002924	Los Angeles County Metropolitan Transit Authority (CA)	METROPOLITAN TRANSPORTATION AUTHORITY	$208.86	08/11/2025	09/10/2025	84
CB25-0002923	Sedgwick Claims Management Services	SECURITAS SECURITY SERVICES USA, INC	$297.78	08/11/2025	09/10/2025	84
CB25-0002919	ESIS, Inc.	WINN RESIDENTIAL LIMITED PARTNERSHIP	$297.78	08/11/2025	09/10/2025	84
CB25-0002918	ESIS, Inc.	Golden Queen Mining Company	$208.86	08/11/2025	09/10/2025	84
CB25-0002955	Liberty Mutual Insurance	UPS	$1,308.20	08/12/2025	09/11/2025	83
CB25-0002954	Liberty Mutual Insurance	SUGAR FOODS CORP	$288.17	08/12/2025	09/11/2025	83
CB25-0002953	Gallagher Bassett	VOLT INFORMATION SCHIENCES, INC	$212.42	08/12/2025	09/11/2025	83
CB25-0002984	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	08/13/2025	09/12/2025	82
CB25-0003025	PMA Companies	Eclipse Advantage Acquisition, Inc	$270.49	08/14/2025	09/13/2025	81
CB25-0003024	Sedgwick Claims Management Services	DJD DWYER CORP.	$288.17	08/14/2025	09/13/2025	81
CB25-0003020	Zurich Insurance North America	TUTOR PERINI CORPORATION	$435.59	08/14/2025	09/13/2025	81
CB25-0003097	Sedgwick Claims Management Services	RALPH GROCERY COMPANY	$531.36	08/19/2025	09/18/2025	76
CB25-0003095	Sedgwick Claims Management Services	ARCADIA USD	$131.30	08/19/2025	09/18/2025	76
CB25-0003094	CNA Insurance	KNOX ATTORNEY SERVICE, INC	$297.78	08/19/2025	09/18/2025	76
CB25-0003093	ESIS, Inc.	LARGO CONCRETE	$208.86	08/19/2025	09/18/2025	76
CB25-0003118	Sedgwick Claims Management Services	COUNTY OF LOS ANGELES/ AGING AND DISABILITIES	$531.36	08/21/2025	09/20/2025	74
CB25-0003191	Gallagher Bassett	Holiday Rock	$213.43	08/28/2025	09/27/2025	67
CB25-0003280	Sedgwick Claims Management Services	UNITED CEREBRAL PALSY OF LA & VENTURA CO.	$393.83	09/03/2025	10/03/2025	61
CB25-0003279	Sedgwick Claims Management Services	Northrop Grumman Systems Corporation	$1,500.00	09/03/2025	10/03/2025	61
CB25-0003278	ESIS, Inc.	Group 1 automotive Inc	$1,500.00	09/03/2025	10/03/2025	61
CB25-0003277	ESIS, Inc.	Allied Universal	$403.50	09/03/2025	10/03/2025	61
CB25-0003271	AmTrust North America	Paul Herrera Individual	$102.55	09/03/2025	10/03/2025	61
CB25-0003270	Gallagher Bassett	Bright Horizons	$152.53	09/03/2025	10/03/2025	61
CB25-0003322	Gallagher Bassett	RTE Enterprises	$222.15	09/08/2025	10/08/2025	56
CB25-0003321	Liberty Mutual Insurance	Glenair, Inc.	$1,561.17	09/08/2025	10/08/2025	56
CB25-0003320	AmTrust North America	House of Lumbeer & Hardware, LLC	$531.36	09/08/2025	10/08/2025	56
CB25-0003319	AmTrust North America	LA PARILLA RESTAURANT	$5,509.91	09/08/2025	10/08/2025	56
CB25-0003393	Athens Administrators	Quality Comp Inc.	$386.70	09/16/2025	10/16/2025	48
CB25-0003392	Athens Administrators	Quality Comp Inc.	$386.70	09/16/2025	10/16/2025	48
CB25-0003391	Athens Administrators	Quality Comp Inc.	$386.70	09/16/2025	10/16/2025	48
CB25-0003390	Athens Administrators	Quality Comp Inc.	$386.70	09/16/2025	10/16/2025	48
CB25-0003389	Athens Administrators	Quality Comp Inc.	$386.70	09/16/2025	10/16/2025	48
CB25-0003388	Athens Administrators	Good Samaritan Hospital	$698.00	09/16/2025	10/16/2025	48
CB25-0003385	ESIS, Inc.	VERTEX AEROSPACE SERVICES	$429.61	09/16/2025	10/16/2025	48
CB25-0003415	Gallagher Bassett	ASHLEY FURNITURE	$152.53	09/17/2025	10/17/2025	47
CB25-0003414	Gallagher Bassett	American Medical Response	$152.53	09/17/2025	10/17/2025	47
CB25-0003413	Gallagher Bassett	GENERAL CONTRACTOR	$260.36	09/17/2025	10/17/2025	47
CB25-0003412	Gallagher Bassett	GENERAL CONTRACTOR	$102.34	09/17/2025	10/17/2025	47
CB25-0003470	Sedgwick Claims Management Services	YRC Inc. DBA YRC FREIGHT	$288.17	09/24/2025	10/24/2025	40
CB25-0003494	Helmsman Management Services	ADP TOTAL SOURCE GROUP, INC/PETS GLOBAL, INC	$531.36	09/25/2025	10/25/2025	39
CB25-0003509	The Walt Disney Company	DISNEYLAND RESORT	$393.83	09/26/2025	10/26/2025	38
CB25-0003508	Helmsman Management Services	ADP Total Source Group	$288.17	09/26/2025	10/26/2025	38
CB25-0003507	AmTrust North America	OM Foods Hollywood, Inc.	$311.28	09/26/2025	10/26/2025	38
CB25-0003537	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003536	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003535	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003534	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003533	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003531	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003530	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003529	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003528	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003527	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003525	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003524	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003521	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003520	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003519	Southern California Edison	Southern California Edison	$386.70	09/29/2025	10/29/2025	35
CB25-0003570	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003569	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003567	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003565	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003564	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003563	Southern California Edison	Southern California Edison	$386.70	10/01/2025	10/31/2025	33
CB25-0003562	Gallagher Bassett	C. A. Rasmussen, Inc.	$248.82	10/01/2025	10/31/2025	33
CB25-0003560	State Compensation Insurance Fund	BUILD ABILITY	$103.33	10/01/2025	10/31/2025	33
CB25-0003582	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003580	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003578	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003577	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003576	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003575	Southern California Edison	Southern California Edison	$386.70	10/02/2025	11/01/2025	32
CB25-0003619	AmTrust North America	PURA VIDA WELLNESS, INC	$288.17	10/03/2025	11/02/2025	31
CB25-0003618	ESIS, Inc.	MV TRANSPORTATION	$386.70	10/03/2025	11/02/2025	31
CB25-0003617	ESIS, Inc.	MV TRANSPORTATION	$311.28	10/03/2025	11/02/2025	31

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