RJN Investigations
The Stockwell Firm adjustercom publishes your thoughts and ideas...


Other Claims News
The Comp Examiner Directory
The Liability Adjuster Directory
Service Provider Directory
Post a Job
View Jobs
View Resumes
Contact Us

The Comp Examiner Directory


The Comp Examiner Directory


SLT Law - Stacey Tokunaga


Welcome Guest! | Login | Register with adjustercom

News Main Page

Email a Friend Email A Friend

More News

December 6, 2019
California Department of Insurance Arrests Suspects In San Diego Organized Auto Fraud Ring In $500,000 Operation Dealer’s Choice

November 29, 2019
Former NFL Tight End Kellen Winslow Sr. Files Workers' Compensation Claim Claiming Brain Injury

November 23, 2019
Darrell Brown, Sedgwick So Cal Claims Executive, Dies At Age 52. His Memorial To Be Held on November 30th 2019 In Inglewood, California

November 23, 2019
California Division of Workers’ Compensation Announces 2020 Profile Audit Review and Full Compliance Audit Performance

Independent Medical Report Details Steady Activity and Outcomes
By Lonce Lamonte and the DWC Newsline - November 19, 2019

The California Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted a progress report on the Department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process for the state’s workers’ compensation system that uses medical expertise to obtain consistent, evidence-based decisions.

The report describes IMR program activity in 2018, the sixth year since the program was implemented. The Independent Medical Review Organization administering the program, Maximus Federal Services, Inc., received over 250,000 IMR applications, and issued almost 185,000 Final Determination Letters, each containing one or more medical necessity disputes.

Highlights of the report:

  • The monthly average length of time to issue an IMR determination after receipt of all medical records had decreased to nine days toward the end of 2018.
  • An average of 15,400 IMR decisions were issued each month.
  • The number of eligible applications increased for the sixth consecutive year.

  • Case decisions continued to be similar when comparing several demographic categories, including injured workers’ date of injury, their representation status, and the geographic region of their residence.

  • Treatment request denials were overturned at a rate of 10.33 percent, with specialist consultations, office visits and mental health services overturned most often.
  • More than 40 percent of treatment requests sent for IMR were for pharmaceuticals, with opioids comprising nearly one of every three pharmaceutical requests.

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

 The progress report is posted on the DIR website.

# # #, Lonce Lamonte, journalist and editor, with the DWC Newsline release of November 15th 2019


 Hot Jobs

News writer
can work from anywhere - freelance

adjustercom newsletter writer
no specific location required - freelance

Writer of People Profiles
no specific location required
View All Jobs

Build Your Brand

Veatch Carlson

    Copyright 2019 | Privacy Policy | Feedback |  

Web site engine's code is Copyright © 2003 by PHP-Nuke. All Rights Reserved. PHP-Nuke is Free Software released under the GNU/GPL license.