Delineating Dubon: Strategic Considerations and a Winning Game Plan

by Patrick C. Gorman (May 15, 2014)

I recently had the opportunity to review the Dubon ruling at length and wanted to outline some key points to consider when dealing with a challenge to a UR determination on the grounds the determination contains material procedural defects.

The Dubon case has resulted to dramatic changes in the litigation strategy of applicant attorney’s (an applicant’s attorney referred to Dubon as a “game changer”).  Dubon states that IMR solely resolves disputes over the “medical necessity” of treatment requests while the WCAB retains jurisdiction to determine whether or not the utilization review decision suffers from material procedural defects.