The case names and scenarios in this post are illustrative. The skill behavior described is what ships in v4.5.136+.
An IMR decision lands in your mail queue. The carrier appealed your treating physician's request for lumbar epidural injections; Maximus upheld the UR denial. The document has a clear 30-day deadline to seek WCAB review under LC 4610.6(h).
What do you want the assistant to do?
That's the question. And the right answer depends on facts the assistant doesn't know:
- Is the reviewer's specialty a mismatch for the treatment? (a real WCAB challenge ground)
- Was the UR decision underlying it untimely? (separate Sandhagen/Dubon challenge)
- Did the client tell you yesterday they don't want to pursue this treatment anymore?
- Are you about to settle the case anyway?
The honest answer is: it depends. And the previous version of mail processing didn't ask. It saw doc_type: imr-decision and auto-proposed a generic "follow up on IMR decision" task with normal priority and a vague due date. The attorney either:
- Accepted the noise task and ignored it (most common)
- Edited it to match what they actually planned to do
- Skipped it and made a real task elsewhere
None of those are good. The first creates audit-log clutter and missed deadlines. The second is friction. The third splits the case record across two places.
The new flow
For five document types, the assistant now stops between the binding check and the proposed actions. It does not preview a recommended task. It does not pre-mark anything with a star. It asks:
IMR Decision found. This is the determination on a UR appeal —
the 30-day window to seek WCAB review of the IMR ran from the
IMR decision date. Strategy options:
1. Appeal the IMR (file petition with WCAB under LC 4610.6(h))
Creates: HIGH-priority attorney task with 30-day deadline,
calendar event for the deadline.
2. Note the appeal deadline only — attorney decides later.
Creates: NORMAL-priority task with 30-day deadline reminder.
3. No appeal — accept the determination. Creates: a record
activity but no follow-up task.
4. File the document only — no task, no event. Attorney will
handle outside the assistant.
Which? (1/2/3/4)Pick. The assistant then builds the actions to match.
The five doc types
This treatment applies where deadlines matter AND multiple strategies are reasonable:
- IMR Decision — 4 options (appeal, defer, accept, file only)
- UR Decision — 5 options (IMR appeal, timing challenge under Sandhagen/Dubon, defer, accept, file only)
- QME Report — 5 options (object, request supplemental, accept-and-rate, defer, file only)
- DOR / DOR Objection — 4 options (response if defense's, hearing prep if ours, defer, file only)
- Notice of Hearing — 3 options (prep with checklist, calendar only, file only)
Other documents — subpoenas, medical records, carrier correspondence, settlements, F&A awards — go straight to the proposed actions step. Their default proposals are usually right; adding a strategy question for every mail item would be friction without benefit.
What this means for the task list
The attorney's task list now reflects what the attorney decided to do, not what the assistant guessed. When you walk tasks the next morning, every item is one you affirmatively chose to create. If a task says "file IMR appeal — deadline June 15," that's because you said "yes, appeal." If there's no task on an IMR decision, that's because you said "no appeal — accept."
The byproduct: the audit log records not just the writes but the strategic reasoning. The activity for the IMR decision is filed regardless of strategy. The task — and its priority, assignee, due date — reflects the chosen option. Six months later, when a question arises about why this IMR wasn't appealed, the answer is in the record: option 3 chosen on this date, no task created, activity filed.
Strategies the model doesn't see
The five strategies aren't exhaustive. The attorney might want to do something the option list doesn't cover — a settlement-conditioned appeal, a hold pending QME, a join-with-companion-case maneuver. After picking a strategy, the proposal step still allows editing — change the assignee, edit the description, change the priority, add a different deadline.
What changed is that the default isn't a generic task. The default is a question.
Bonus: UR and IMR are different documents
The previous extraction template covered "UR denial." There was no IMR-decision template — the assistant was using the UR-denial template for both. They're related but different documents with different legal standards and different challenge mechanics:
- UR Decision — the carrier's medical-necessity review. Standard is the MTUS guidelines. Appeal mechanism: file DWC Form IMR within 30 days. Timing challenges available under LC 4610(i) and Sandhagen/Dubon.
- IMR Decision — Maximus's review of the UR decision. Standard is LC 4610.6(h) — narrow grounds: fraud, conflict, bias, administrative overreach, or plain error. WCAB review within 30 days. Reviewer specialty mismatch is the strongest practical challenge.
The new IMR-decision template captures the IMR-specific fields: reviewer specialty, reviewer licensure, MTUS guideline cited, outcome (uphold/overturn/partial), and the LC 4610.6(h) grounds for review. The model can now extract those correctly and present them in the strategy question.
Why this matters for compliance
Two practical things:
- Deadlines that should be calendared get calendared. If you pick option 1 or 2 on a UR or IMR, the assistant builds a calendar event for the deadline. Picking option 4 (file only) skips it — which is correct when you've already decided not to act.
- Tasks attributed to the right person reflect attorney judgment. Picking "appeal" assigns the task to an attorney (HIGH priority). Picking "defer" creates a normal task that any staff member can handle as a reminder. The priority and assignee come from the strategy, not from a generic template.
The assistant is no longer guessing at intent. It's surfacing the choice, then executing what you chose.