Report on California’s Independent Medical Review Shows Continued Progress

By | September 10, 2018

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 last week 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.

The report can be viewed on DWC’s website.

Related:

Was this article valuable?

Here are more articles you may enjoy.