Report: Nearly All California Worker’s Comp IMR Filings Were Eligible for Review

Nearly all independent medical review filings were deemed eligible for review last year, slightly less than the annual percentage for those filed in 2022, according to California Division of Workers’ Compensation’s annual report on the IMR program.

IMR is the medical dispute resolution process for the state’s workers’ comp system that resolves disputes over medical treatment for injured workers. The report describes IMR program activity in 2023, the 10th year since the program was implemented.

The organization administering the program, Maximus Federal Services, Inc., reported receiving 175,027 IMR applications, and issuing 130,774 Final Determination Letters, each addressing one or more medical necessity disputes. The IMRO issued decisions on average eight to nine days after receipt of all medical records, according to the report.

Other highlights of the report include:

• Nearly 92% of all unique IMR filings were deemed eligible for review, slightly less than the annual percentage for those filed in 2022.
• Pharmaceutical requests accounted for 31% of all treatment requests sent for IMR, a slightly higher proportion of total service requests than in previous years.
• Opioids comprised 26% of all pharmaceutical requests.
• Treatment request denials were overturned at an overall rate of 10.2%. Behavior and Mental Health Services, Evaluation and Management, Programs were overturned the most often.
• Guidelines contained in the Medical Treatment Utilization Schedule continue to serve as the primary resource for the determination of medical necessity.

The report is posted on the Department of Industrial Relations website.

Topics California Workers' Compensation