July 20, 2017

CA DWC: Independent Medical Review Report Shows Progress

San Francisco, CA – The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) recently posted a progress report on the department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process that uses medical expertise to obtain consistent, evidence-based decisions and is one of the most important components of Senate Bill 863, Governor Brown’s landmark 2012 workers’ compensation reform.

The 2017 Independent Medical Review Report: Analysis of 2016 Data provides an evaluation of the program during the third complete year in which IMR data was available for all dates of injury. The report features comparisons with figures provided in the previous report (PDF), the 2016 Independent Medical Review Report: Analysis of 2014–2015 Data.

Highlights of the report include:

  • The average number of days from when the IMR case is assigned to when it is decided was cut nearly in half between the beginning and end of the year, from 24 days to 14 days.
  • The number of eligible applications and the number of cases decided increased slightly from the year prior.
  • Case decisions are extremely similar when comparing several demographic categories, including the injured workers’ date of injury, their representation status, and the geographic region of their residence.

Other findings:

  • At least 13,000 IMR decisions are issued every month.
  • The monthly total for number of applications deemed ineligible has been cut by nearly one-third between January and December of 2016.
  • More than 40% of all treatment requests are for pharmaceuticals. Three of every 10 pharmaceutical evaluations are for opioids.
  • The majority of physician reviewers who provided decisions in 2016 were licensed in California. Nearly two-thirds of all IMR determinations were decided by Physical Medicine & Rehabilitation, Occupational Medicine and Family Practice specialists.

Click here for the Report: 2017 Independent Medical Review (IMR) Report: Analysis of 2016 Data

Source: CA DWC

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