San Francisco, CA – The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted an annual report on the Department’s Independent Medical Review (IMR) program.
IMR is the medical dispute resolution process for the state’s workers’ compensation system that resolves disputes about the medical treatment of injured workers. The report describes IMR program activity in 2021, the eighth year since the program was implemented.
The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 178,927 IMR applications, and issued 133,400 Final Determination Letters, each addressing one or more medical necessity disputes. Throughout the year, the IMRO issued decisions, on average, nine to ten days after receipt of all medical records.
Some highlights of the report:
- Nearly 94% of all unique IMR filings were deemed eligible for review, the same annual percentage as for those filed in 2020.
- Pharmaceutical requests accounted for 31% of all treatment requests sent for IMR, a smaller proportion of total service requests than in previous years.
- Opioids comprised 27% of all pharmaceutical requests.
- Treatment request denials were overturned at a rate of 7.2%. Specialist consultants, office visits and mental health services were overturned 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 DIR website: CA DIR: Independent Medical Review (IMR) Report for 2021
Source: CA DIR