Labor Code §4610 is a critical statute governing how medical treatment requests are reviewed and either approved or denied by insurance companies in the California workers’ compensation system. This process is known as Utilization Review (UR) — and it can often determine whether an injured worker receives timely care or is left waiting.
Text of Labor Code §4610 (Abbreviated for Clarity)
(g) Additional procedural safeguards apply—including accreditation requirements, nondisclosure of conflicts of interest, and reporting mandates.
California Labor Code §4610 (pre‑2024 version via FindLaw)
(a) For purposes of this section, “utilization review” means utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, delay, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians … pursuant to Section 4600.
(b) Every employer shall establish a utilization review process in compliance with this section, either directly or through its insurer or an entity;
(c) Each utilization review process shall be governed by written policies … consistent with the schedule for medical treatment utilization … adopted pursuant to Section 5307.27 … shall be filed with the administrative director and disclosed upon request.(d) If an employer … requests medical information … it shall request only what is reasonably necessary …; must employ or designate a medical director …
(e) No person other than a licensed physician … may modify, delay, or deny requests for medical treatment for medical necessity.
(f) The criteria or guidelines used in the utilization review process … must be:
- Developed with involvement from practicing physicians.
- Consistent with the MTUS and formulary adopted under § 5307.27.
- Evaluated at least annually.
- Disclosed to physician and employee when used in specific case.
- Available to the public upon request.
What Is Utilization Review?
Utilization Review (UR) is the process by which insurance companies or third-party administrators decide whether to approve, modify, delay, or deny medical treatment requested by your treating physician. UR decisions are based on California’s Medical Treatment Utilization Schedule (MTUS) and must be performed by licensed medical professionals.
How Does UR Impact Injured Workers?
- Delays in Treatment: A treatment that your doctor recommends can’t move forward until UR approves it.
- Risk of Denial: If a UR reviewer deems the treatment unnecessary—even without personally examining you—it can be denied.
- Short Timelines: By law, UR decisions must be issued within five working days of receipt of the request (or 72 hours for urgent cases).
Your Rights if Treatment Is Denied
If UR denies or modifies your treatment:
- You can appeal through Independent Medical Review (IMR) under Labor Code §4610.5.
- It’s important to act quickly—you generally have 30 days to request an IMR.
- Having a skilled workers’ compensation attorney can help ensure deadlines are met and medical evidence is submitted properly.
Why This Code Matters
UR is one of the most controversial aspects of the workers’ comp system. It often results in valid treatment being delayed or denied, hurting recovery and prolonging cases. Labor Code §4610 was intended to ensure review decisions are medical—not financial—but in practice, workers frequently need to fight back to get the care they deserve.
Learn More About Workers’ Compensation
Want to understand more about the system? Check out our blog on
👉 Top 25 Labor Codes Every Injured Worker Should Know
Final Thoughts
Labor Code §4610 is your safeguard for medical treatment for injured workers. If you disagree with a treating physician’s opinion—or your treatment is being cut off—don’t delay. The clock is ticking.
Contact Employees First Labor Law to make sure your medical rights are protected and your recovery isn’t compromised.
