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Report on California’s Independent Medical Review Shows Continued Progress

An annual progress report from the California Department of Workers’ Compensation’s Independent Medical Review program shows it’s working as intended.

IMR is a medical dispute resolution process that uses medical expertise to obtain consistent, evidence-based decisions and is a component of Senate Bill 863, the 2012 workers’ comp reform law.

David Lanier, secretary of the California Labor and Workforce Development Agency, said in early September that $1.3 billion in annual savings have been realized since the reforms went into effect and he credited the IMR process in part for those savings.

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 compared with 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 10 pharmaceutical requests for opioids.

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