California Workers’ Comp Medical Review Runs Through 13K Disputes Each Month

July 14, 2017

A new progress report from the California Department of Industrial Relations on the department’s independent medical review program shows that 13,000 decisions run through the medical dispute resolution process each month.

The report, 2017 Independent Medical Review Report: Analysis of 2016 Data, provides an evaluation of the program during the third complete year in which IMR data was available for all dates of injury.

Highlights of the report include:

  • The average number of days from when the IMR case is assigned to when it is decided was cut nearly in half between the beginning and end of the year, from 24 days to 14 days.
  • The number of eligible applications and the number of cases decided increased slightly from the year prior.
  • Case decisions are extremely similar when comparing several demographic categories, including the injured workers’ date of injury, their representation status, and the geographic region of their residence.
  • At least 13,000 IMR decisions are issued every month.
  • The monthly total for number of applications deemed ineligible has been cut by nearly one-third between January and December of 2016.
  • More than 40 percent of all treatment requests are for pharmaceuticals. Three of every 10 pharmaceutical evaluations are for opioids.

The progress report is posted on the DIR website.

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