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.
- 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.
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