Today’s issue of WorkCompRecap features the CA DIR & DWC’s recent release of the 2019 edition of the progress report on the Independent Medical Review (IMR) medical dispute resolution program for workers’ comp.
2019 was the seventh year since the program was implemented. Administrator Maximus Federal Services received over 222,000 IMR applications and issued almost 164,000 Final Determination Letters, each addressing one or more medical necessity disputes. Key findings from the report included that denials were overturned at a rate of 10.4%, with specialist consultations, office visits and mental health services overturned most often. Pharmaceuticals accounted for 36.7% of IMR requests, with opioids making up nearly 1 in 3 pharmaceutical requests.
Find out more (including a link to the free report!) by clicking here!