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Everything here is free to read, and nothing here is a claim about your case. Built from California’s published records and modified by us — not official government data. How these numbers were made.

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Cited authority · 2021-2025 · California

FDA

Independent medical reviewers in California named FDA in 2,151 published decisions over 2021-2025. These are the disputes it turned up in.

74.2%

Overturned
1,595 of 2,151
Era
2021-2025
Jurisdiction
California DMHC IMR
1,595 overturned556 upheld

What this number is, and is not. It is the outcome of decisions in which the authority was named — not the effect of naming it. Reviewers cite the standard they applied, so the citation and the outcome share a cause. Read it as “disputes where this standard was the yardstick came out this way”, never as “citing this standard produces this result”.

These count only denials appealed all the way to independent review. Fewer than 1% of denials are appealed internally at all, so a share here is not the share of denials that are wrong — it is the share of contested ones reviewers did not sustain. California only, and only plans the state regulates: not self-funded employer plans, Medicare or Medicaid.

Free help. The California DMHC Help Center files an Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov. It is the same review these decisions came from, and you do not need us or a lawyer to reach it.

What stands out here

computed from this standard

  • against the market

    Decisions naming FDA came out at 74.2%, 9 points above the 65.2% across all published decisions in this era. Reviewers reach for a standard when it settles the question, so the citation and the outcome share a cause.

  • where it is used

    It appears most in pharmacy disputes — 1,817 of the 2,151 decisions citing it, 84% of its whole footprint, at 78.2%.

  • the condition behind it

    The condition it is most often applied to is endocrine & metabolic (n=923, 83.9% overturned).

Treatment classes

computed
  • Pharmacy78.2%1,817
  • Cancer Care39.8%83
  • Durable medical equipment78.9%38
  • Diagnostic imaging & screening66.7%36
  • Orthopedic procedures16.7%36
  • Pain Management40.0%35

Condition classes

computed
  • Endocrine & metabolic83.9%923
  • CNS & neuromuscular82.2%264
  • Skin86.5%215
  • Cancer44.5%119
  • Orthopedic & musculoskeletal30.4%112
  • Digestive & GI74.4%90