According to a recent study published by the California Workers’ Compensation Institute (CWCI), there has been a sudden and sharp decline in the use of independent medical reviews (IMRs) in workers’ compensation claims in California over the past six years. In fact, the number of IMR decision letters issued hit a record low in the state in 2021. In this blog post, our Sacramento workers’ compensation defense attorney discusses the findings in the study published by the CWCI.
Background: Independent Medical Review (IMR)
In California, all employers are required to provide their staff with no-fault workers’ compensation insurance coverage. When someone is hurt on the job, they are entitled to coverage for all medical care that is reasonably necessary and related to their accident. Of course, there can sometimes be disputes between employers/claims administrators/insurers and employees over what type of medical care is truly reasonable and necessary.
California’s independent medical review (IMR) process exists to help resolve these types of disagreements. The California Department of Industrial Relations (DIR) explains that the IMR system is an alternative to court. It is designed to allow parties with access to independent doctors and medical professionals who can examine an injured worker and help determine what type of treatment is proper.
CWCI Study: Independent Medical Reviews Hit a Record Low in 2021
On March 23, 2022, the California Workers’ Compensation Institute (CWCI) published a report finding that independent medical reviews (IMRs) have been plummeting in the state in recent years. The CWCI compiled more than one million IMR decision letters which were sent out between the years of 2015 and 2021. Here are four of the most notable things the CWCI found:
- IMR Volume is Way Down: To start, the headline finding from the report is that IMR volume is down sharply in California. The total number of IMRs have dropped nearly 25% in the last six years.
- Prescription Drugs Remain a Top Area of Dispute: The data is consistent: Prescription drug disputes remain the top cause of IMRs. More than one-third of all IMRs are driven primarily by disputes over the necessity of prescription medication.
- Most Denials are Upheld: Notably, most workers’ compensation denials for medical coverage are upheld by IMRs. Somewhere between 80% and 90% of denials are ultimately upheld by the independent doctor.
- A Small Number of Doctors Drive IMR Requests: Finally, a notable finding from the CWCI is that a small number of physicians in California are responsible for a disproportionate share of IMR requests. The top 1% of doctors account for 40% of all IMR requests.
At Yrulegui & Roberts, our Sacramento workers’ compensation defense lawyers have the legal expertise that clients can rely on. If you have any questions about the IMR process, we are here to help. Contact us now to arrange a confidential, no obligation initial appointment with an attorney. We provide workers’ compensation defense in Sacramento County and throughout all of Central California.