News Archive

Email A Friend

More News

May 3, 2024
To Clarify What “File” Means With Workers’ Compensation Claims. The Connecticut Supreme Court Does It.

April 25, 2024
California Department of Industrial Relations and Cal/OSHA Will Honor Workers’ Memorial Day at Four Events in California on April 28th-29th 2024. Cal/OSHA Joining Partners in Arcadia, Richmond, San Diego and San Francisco.

April 23, 2024
California Division of Workers' Compensation Launches Online Portal for Submission of QME Medical-Legal Reports

April 22, 2024
California Division of Workers’ Compensation Posts Updated Time of Hire Notice

The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted an annual 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 resolves disputes about the medical treatment of injured workers. The report describes IMR program activity in 2021, the eighth year since the program was implemented.

The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 178,927 IMR applications, and issued 133,400 Final Determination Letters, each addressing one or more medical necessity disputes. Throughout the year, the IMRO issued decisions, on average, nine to ten days after receipt of all medical records.

Some highlights of the report:

• Nearly 94% of all unique IMR filings were deemed eligible for review, the same annual percentage as for those filed in 2020.
• Pharmaceutical requests accounted for 31% of all treatment requests sent for IMR, a smaller proportion of total service requests than in previous years.
• Opioids comprised 27% of all pharmaceutical requests.
• Treatment request denials were overturned at a rate of 7.2%. Specialist consultants, office visits and mental health services were overturned most often.
• Guidelines contained in the Medical Treatment Utilization Schedule continue to serve as the primary resource for the determination of medical necessity.

The report is posted on the DIR website.

# # #

by adjustercom editor Lonce Lamonte, lonce@adjustercom.com, and the California DIR - DWC Newsline, February 8th 2023