New California Work Comp Laws – Independent Medical Review

As of July 1, 2013, for all dates of injury, California’s workers’ compensation system will use a process called independent medical review (IMR) to resolve disputes about the medical treatment of injured employees.

A request for medical treatment in the workers’ compensation system must first go through a “utilization review” process to confirm that it is medically necessary before it is approved. If utilization review denies, delays or modifies a treating physician’s request for medical treatment because the treatment is deemed not medically necessary, the injured employee can ask for a review of that decision through IMR.

The costs of IMR are paid by employers who are required by law to provide injured employees with all medical treatment that is reasonable and necessary to cure or relieve the effects of a work-related injury. The Department of Workers’ Compensation is required to contract with one or more independent medical review organizations (IMROs), to conduct IMR on its behalf.

There are strict guidelines and time limits that must be followed when requesting an IMR for denied medical treatment.  For example, you have 30 days to request an IMR once you receive a negative utilization review decision.  Then, once an IMR is granted, you then have 20 days to submit all pertinent records that support your position on the denied medical care.

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