"They keep stalling on my surgery."

Check the timing first

Utilization review has strict deadlines running from receipt of the treatment request, with shorter timeframes where the condition is urgent.

A UR decision that is late is defective, and a defective UR decision is not properly resolved through IMR — it can be taken to a workers' compensation judge, which is a materially better forum than a paper review.

Also check: was the decision made by a physician competent in the relevant field? Only a physician may modify or deny for medical necessity. Was it served on everyone required, within the required time? Did it address what was actually requested?

How to check a UR denial in detail.

Then check what your doctor actually sent

Most surgery denials are not really about the surgery. They are about documentation.

Guideline pathways almost always require a documented trial and failure of conservative care first — physical therapy, injections, medication, activity modification, with dates and outcomes. That documentation is frequently in the chart and not in the request.

And the request should respond to the guideline directly, explaining why this worker's presentation fits the pathway — not merely restate the diagnosis.

Check whether the guideline changed. Four MTUS guidelines were replaced effective January 2, 2026 — shoulder, elbow, hand/wrist/forearm, and traumatic brain injury — a further set (initial approaches to treatment, chronic pain, eye disorders) took effect June 1, 2026, and the utilization review regulations were restructured effective April 1, 2026. A denial citing superseded material is citing something that no longer exists.

If your condition is urgent

Expedited review exists. Where a delay would seriously jeopardize your health, the request should be flagged as expedited and the timeframes shorten substantially.

And an expedited hearing before a workers' compensation judge is available for urgent medical treatment disputes — and it is heard in person, not on paper. How hearings work.

Do not stop treating while you fight

A gap in treatment is used against you — on causation, on credibility, and on permanent disability.

And if the delay itself made you worse, that matters. Under Hikida v. WCAB, disability caused by industrial medical treatment is industrial — and a documented deterioration during a wrongful delay is evidence about your permanent disability, not just a grievance. But Hikida was narrowed.* County of Santa Clara v. WCAB (Justice) *(2020) 49 Cal.App.5th 605 [85 Cal.Comp.Cases 467] holds that it "precludes apportionment only where the industrial medical treatment is the sole cause of the permanent disability." Where pre-existing pathology also contributes, §§ 4663 and 4664 apportionment still applies. How apportionment works.

Document everything: each request, each denial, each date, and what changed in your condition while you waited.

And the penalty

A wrongly delayed or refused treatment authorization is delayed compensation. Under § 5814 that can support a penalty of up to 25% or up to $10,000, whichever is less — and where an award has already issued and the employer is one that secured payment under § 3700 — not the illegally uninsured — § 5814.5 permits an award of attorney's fees paid by the employer. How penalties work.