As reported yesterday, the filing fee California providers must pay to request Independent Bill Review (IBR) will increase in 2025, from $180 to $195.

IBR is the process by which the state (represented by private services firm Maximus) resolves disputes initiated by providers over the amount owed for treating an injured worker.

On its face, the increase wouldn’t seem to be bad news for providers; when Maximus rules in the provider’s favor, the claims administrator must reimburse the provider for the fee. In theory, it shouldn’t matter if the fee goes up, since a claims administrator that pays a provider incorrectly is on the hook for it.

Except in reality, the order to reimburse the provider for the IBR filing fee is effectively unenforced.

Thanks to the California Division of Workers’ Compensation (CA DWC), and its apparent, deep-seated commitment to absolute inaction in the face of abuse from claims administrators like Sedgwick, providers cannot assume the IBR filing fee will be returned—even when they prevail at IBR.

CA DWC Leaves IBR Rules Unenforced

For California workers’ comp providers, getting paid can cost a lot.

Besides the high practice expenses required to compliantly bill for injured workers’ treatment, fighting improper payment denials and reductions is another resource-sucker. In effect, the IBR filing fee forces providers to pay for the state intervention that is too often necessary to get a claims administrator to pay what they owe.

Of course, California Code of Regulations Section 9792.5.14 mandates that when Maximus determines that a provider was correct to dispute a payment denial or reduction, the claims administrator is ordered to reimburse the provider for the filing fee. Per Labor Code Section 4603.2, the claims administrator has 45 days from the date of Maximus’ decision to remit all money owed, filing fee included.

However, claims administrators consistently neglect to reimburse providers for the fee, without consequence.

For example, currently claims administrators collectively owe daisyCollect providers (a fraction of our total provider clients) $30,420 in unpaid IBR filing fee reimbursements. As of this writing, Sedgwick holds the record for the longest-overdue IBR filing fee reimbursement at 1,484 days overdue.

Yes, Sedgwick is four years late (and counting) to reimburse at least one provider—and likely many others.

True to form, the CA DWC does nothing about this non-compliance and offers no feasible mechanism by which doctors can pursue missing IBR filing fee reimbursements. In fact, our experience suggests that the only active role the agency takes in IBR disputes is to play deus ex machina on behalf of claims administrators, depriving providers of due reimbursement.

As a result, claims administrators play a game we call “IBR Chicken,” which works as follows:

1. Deny payment on random (demonstrably spurious) grounds and hope the provider doesn’t submit a Second Review appeal.
2. If the provider submits a Second Review appeal on time, deny that (on equally random, spurious grounds) and hope the provider doesn’t spend the time, resources, and filing fee to request IBR.
3. If the provider timely requests IBR, offer to pay the disputed amount in exchange for the provider withdrawing the IBR request (and forfeiting the filing fee).

At best, the provider fails to navigate the appeals gauntlet compliantly, and the claims administrator keeps the reimbursement owed by default. At worst, the claims administrator is forced to pay what they always owed and nothing more…and the CA DWC apparently doesn’t give a cluck.

Since the appeals process consumes so much time and practice resources, and the practice often ends up absorbing the IBR filing fee, many providers simply don’t bother appealing—money in the bank for claims administrators.

State legislators attempted to address this with a bill requiring Maximus to simply bill the losing party in an IBR dispute, but the legislation failed. As a result, the 2025 IBR filing fee increase will likely represent more money funneled from providers’ pockets to claims administrators’ coffers.

With tools for quicker, easier appeals, daisyBill helps your practice demand full reimbursement — with just a few clicks. Learn more or request a demo below:

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