Today’s issue of WorkCompRecap features the California Workers’ Compensation Institute’s release of the latest update to its study on the Independent Medical Review (IMR) process, which is used to resolve workers’ comp medical disputes in the state.
Key findings included that the number of IMR decision letters hit an all-time low in 2021 as pharmaceutical disputes – especially those involving opioids – have continued to decline. Since peaking at 184,735 letters in 2018, IMR letter volume has declined for three years in a row to 133,494 in 2021. CWCI noted that while some of the decline reflects decreasing claim volume in 2020 due to the pandemic, much of it came after the DWC incorporated Chronic Pain and Opioid Guidelines into the MTUS in late 2017 and implemented a Prescription Drug Formulary. After additional formulary changes in 2018, prescription drug disputes declined from ~47% of all IMRs in 2017 to ~35% in 2021, much of which was due to a reduction in opioid disputes, which fell from nearly a third of pharmaceutical IMRs in 2018 to just over a quarter last year.