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 another all-time low in 2022 as prescription drug disputes continued to decline. Since peaking at 184,735 letters in 2018, IMR letter volume has declined to 127,215 in 2022 (down 31%). CWCI also noted that IMR doctors upheld the UR physician’s modification or denial of the service in 91.1% of the 2022 IMRs, down slightly from the record 92.0% uphold rate in 2021. Disputes over prescription drug requests still represented a third of 2022 determinations, but is down from nearly 50% prior to the state’s adoption of Guidelines and implementation of a Formulary. Even then, opioids still accounted for nearly a quarter of 2022 pharmaceutical IMRs, more than any other type of drug, but down from 32.1% in 2018.