Independent Medical Review Coming Soon to a Workers’ Compensation Dispute Near You
Independent Medical Review (IMR) is the new process to be used by the California workers’ compensation system for resolution of disputes involving the medical treatment of injured workers. The IMR process went into effect on January 1 for injuries occurring on or after that date. As of July first, IMR will be the process utilized for everyone regardless of when the injury occurred.
Before a request for medical treatment is approved, the request goes through a utilization review (UR) to determine whether the treatment is medically necessary. In the event a utilization review results in the denial of a request, the injured worker has the right to seek review of the decision through the IMR process.
Who pays for the IMR?
The employer does. Workers’ compensation law requires employers to pay for the medical treatment when their employees are injured on the job. The IMR is part and parcel of the medical treatment process.
Applying for an IMR
Your claims adjustor should provide you with the IMR application form following the utilization review. Make sure you sign the form and submit it along with a copy of the utilization review. This should be done within 30 days of receiving the utilization review determination. Remember, until July 1, this process only applies to workers who were injured this year. After July 1, this process will apply to all injured workers regardless of the date of their injury.
Appeals still available
The IMR is a non-judicial process conducted by a company that contracts with the DWC for the job. If you disagree with the IMR determination, you can appeal within 30 days to the Workers’ Compensation Appeals Board (WCAB). The grounds for appeal are limited however, and the WCAB starts with a presumption that the IMR is correct. The Law Offices of Sef Krell can help protect your rights and work to get you the best result in a WCAB appeal or at any stage of the workers’ compensation process. In Los Angeles, contact the Law Offices of Sef Krell for assistance with your California workers’ compensation claim.