Attorneys Explain California Workers Comp Terms: IMR –
In a California’s workers’ compensation case, “IMR” refers to a process called “Independent Medical Review”.
Any request made by an injured worker’s treating doctor for medical treatment under California Workers’ Compensation has to go through a “utilization review” – to prove that the requested treatment is medically necessary – before it will be approved.
If the treating physician’s request for medical treatment is denied, delayed or modified because the “utilization review” determines that the treatment is not “medically necessary”, the injured worker can ask for an “Independent Medical Review” (IMR).
Effective July 1, 2013, any and all medical treatment disputes will be resolved through the IMR process – rather than through the court system – regardless of the date of the injury. This means even employees whose injuries occurred before the IMR effective date of July 1, 2013 are still entitled to IMRs.
The costs of the injured employee’s IMR (Independent Medical Review) are paid by the employer.
How Does an IMR Work in a Workers Comp Case?
If a worker’s medical treatment is denied, delayed or modified it is the claims administrator’s responsibility to send an injured employee a copy of the “utilization review” decision letter, as well as a completed IMR application form (DWC IMR-1 form).
Then the injured worker – or his/her attorney – must to submit the signed IMR application (along with the UR determination letter) within 30 days of receiving the UR determination to the address on the form.
The IMR will then be reviewed by an independent, third-party government service provider called MAXIMUS. MAXIMUS then utilizes a team of independent health care professionals – including nurses, doctors, physical therapists and other health clinicians – to review the denied request for medical services.
To Learn More About Maximus, CLICK HERE.
Workers Comp Attorneys Can Help With Your IMR
Our experienced Long Beach Workers Compensation attorneys are here to help you with all aspects of your California Workers Comp Case – including your IMR (Independent Medical Review). Our experienced lawyers would be happy to discuss your unique situation with you, to ensure that you receive the maximum workers compensation benefits for which you may qualify.