CA: Annual Report on Independent Medical Review Shows Continued Progress

San Francisco, CA (WorkersCompensation.com) - The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) today 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 Edmund G. Brown Jr.’s landmark 2012 workers’ compensation reform. 

“This shows that Independent Medical Review – which replaced a system where injured workers had to wait for medical treatment while disputes were litigated – continues to provide a timely, efficient process for resolving treatment disputes and supporting appropriate care,” said George Parisotto, DWC Administrative Director. “For the last few years, DIR and DWC have worked to reduce the average number of days to complete IMR decisions. We continue with the ongoing efforts to enhance the program, including Medical Treatment Utilization Schedule updates, adopting the drug formulary and posting public copies of more than 660,000 IMR final determinations.”

Highlights of the report include:

• The monthly average length of time to issue an IMR determination after the receipt of all medical records ranged from 10 days to 14 days, as compared to a high of 24 days in 2016. 

• An average of 14,350 IMR decisions were issued each month in 2017. 

• The number of eligible applications increased for the fifth consecutive year. 

• Case decisions continue to be similar when comparing several demographic categories, including the injured workers’ date of injury, their representation status, and the geographic region of their residence.      

• Similar to prior years, over 40 percent of treatment requests sent for IMR are for pharmaceuticals, with three of every ten pharmaceutical requests for opioids. 

• Guidelines contained in the Medical Treatment Utilization Schedule continue to be the primary resource for the determination of medical necessity. 

Today’s report, as well as previous reports on IMR data, are posted on DWC’s IMR webpage under IMR program updates.

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