Workers’ Comp Claim IMRs

California Seeing Increased Workers Comp Independent Medical Reviews

When an injured California worker’s doctor recommends treatment, that recommendation does not always go straight to care. Many workers are surprised to learn that their treating physician’s request must first pass through a utilization review process – and if the request is modified or denied, the case may head to Independent Medical Review.

Recent state and industry reports show these Independent Medical Reviews are on the rise again. The California Workers’ Compensation Institute (CWCI) reported that after declining steadily from 2018 through 2022, IMR decision letters rose 2.9% in 2023, 8.2% in 2024, and 13% in the first quarter of 2025.

The experienced California workers comp attorneys at Cantrell Green, based in Long Beach, help injured workers understand what these workers comp Independent Medical Reviews mean for their care – and protect your rights during the IMR process.

What Is a California Independent Medical Review?

An Independent Medical Review, or IMR, is the state-mandated process for resolving disputes over medical treatment in California’s workers’ compensation system. When a utilization review physician modifies or denies a treatment request from an injured worker’s treating doctor, the worker can ask for an IMR to challenge that decision.

The review is conducted by physicians selected by an independent organization – currently Maximus Federal Services, Inc. – rather than by the insurer. The goal is to have a medical dispute decided by a doctor unconnected to the parties. The IMR system was created by Senate Bill 863 and has been in operation for more than a decade.

Understanding what an IMR really is — and what it isn’t — is often the first step toward pushing back on a treatment denial. It’s a conversation the California workers comp attorneys at Cantrell Green have with injured workers all the time.

Why Workers’ Comp Treatment Is Being Denied More Often

The recent uptick in Independent Medical Reviews reflects the broader reality that treatment denials and modifications have become common. Utilization review is used to check treatment requests against California’s Medical Treatment Utilization Schedule, and requests that fall outside the guidelines – or that are viewed as poorly documented – can be modified or denied.

According to CWCI, prescription drug disputes remain the most common category of IMR issues, though their share has declined over time as physical therapy, injections, and durable medical equipment disputes have grown. The state’s 2025 IMR report noted that pharmaceutical requests accounted for 30.6% of disputes.

Insurers rely on utilization review to keep a lid on costs, but a denial is not the end of the story. Cantrell Green’s California workers comp attorneys have made a career of pushing back on modifications and denials where the medicine supports the treatment their clients need.

How the Independent Medical Review Process Works

The IMR process starts when the injured worker (or their representative) submits an application after receiving a utilization review decision that denied or modified a treatment request. Supporting medical records are then compiled and sent to the reviewing organization, which assigns the case to a qualified physician reviewer.

According to the state’s most recent report, once all medical records were received, the review organization issued IMR final determinations in an average of six to seven days during 2025. Reviewers with California licenses handled 85% of cases, and many were board-certified in areas such as Occupational Medicine, Physical Medicine and Rehabilitation, Pain Medicine, or Orthopedic Surgery.

Small details in how a request is documented can make a real difference in the reviewer’s decision — which is why guidance from a workers comp attorney can matter as much as the medicine itself. Cantrell Green has spent more than forty years helping injured Californians put together the strongest possible IMR case before the record is closed.

What Happens If an Independent Medical Review Upholds a Denial?

Most IMR decisions uphold the original denial or modification. The state’s 2025 report showed the Independent Medical Review Organization overturned only 10.2% of utilization review denials, down from 12.7% the year before. In other words, roughly nine out of ten denials stand.

When a denial is upheld, the ability to challenge the decision is limited. The law allows appeals only on narrow grounds, and an IMR decision generally stands for one year for the same treatment. That can leave an injured worker waiting months while symptoms and impairment continue.

An upheld denial does not have to be a dead end. Other treatment approaches, changed circumstances, and additional evidence can all open new doors — and figuring out which one to open is the kind of problem Cantrell Green’s California workers comp attorneys have worked through with injured workers many times before.

Protecting Your Rights During a California Independent Medical Review

Because the odds of overturning a denial are challenging, preparation matters. A well-supported request – with clear medical reasoning, references to applicable guidelines, and complete records – stands a better chance than a bare request that leaves the reviewer to fill in the gaps.

Deadlines also matter. Once a utilization review decision is issued, injured workers have a limited time to file for IMR, and missing that window can foreclose the opportunity entirely. Even small procedural missteps can turn a strong medical case into a lost one.

Meeting deadlines, presenting strong medical support, and protecting a worker’s rights from filing through final determination is exactly the work the California workers comp attorneys at Cantrell Green do day in and day out — for injured Californians whose care and future are on the line.

Workers Comp Independent Medical Reviews | California

If you are a California worker whose recommended medical treatment has been delayed or denied, you do not have to face the Independent Medical Review process on your own. These reviews decide whether you get the care your doctor believes you need, and preparation can make a real difference. The compassionate and experienced California workers comp attorneys at Cantrell Green, based in Long Beach, have more than forty years of experience protecting injured workers, and they are ready to explain the Independent Medical Review process, help you build the strongest possible case, and pursue the medical care and benefits you deserve. Reach out today for a friendly, no-pressure conversation about your claim.

California Workers Compensation Attorneys: 800-964-8047