DIR: California Independent Medical Review Shows Improvements

November 16, 2016

A California Department of Industrial Relations progress report shows continuing improvement of the state’s Independent Medical Review process.

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

The 2016 IMR report charts the progress of IMR following its successful implementation in July 2013. In the second and third year of IMR, the average number of days to complete IMRs dropped from 56 days in late 2014 to 10 days by mid-2015.

Among the other findings in the report is that more than one-fourth of IMR cases are filed in Los Angeles, with the Bay Area second with about 20 percent of the state total. Most injured workers with an IMR case are represented by an attorney. Ratios of case outcomes were almost identical for represented and unrepresented injured workers, with more than 80 percent of items and services deemed medically unnecessary by utilization review decision being upheld by IMR reviewers. The rate of treatment disputes overturned is between 9 and 11 percent.

workers-compPharmaceuticals were the most common treatment category in dispute (49 percent in 2015), with requests for rehabilitation services a distant second. The most requested drugs were opioids.

“The report shows IMR is working as intended,” DIR Director Christine Baker said in a statement. “There is an effective process to support appropriate care and stop inappropriate care. The data is showing where further improvements are needed, particularly regarding medical treatment guidelines and education, and we will continue to make adjustments.”


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