When a worker suffers an injury on the job in California, it is not always an easy process to get an approval for workers’ compensation. If there is a dispute about the workers’ compensation benefits, there will be an independent medical review. An IMR is viewed as more time and cost-efficient than going all the way to court. For people who are seeking workers’ compensation, it is important to know how an IMR can be beneficial to the case.
When there is a request for medical treatment, there will be a utilization review to ensure that it is medically necessary. When there is a delay, denial or modification to a request from the treating physician due to it not being medically necessary, the employee can ask for the IMR. The employer pays for the IMR as required by law as is necessary and reasonable to cure the work-related injury.
The IMR’s cost is contingent on the treatment dispute and how many medical professionals will be needed to settle it. Despite that, it is still a cost-effective way to handle these cases when compared to litigation. When it is decided that a case is eligible for an IMR, the parties will get a Notice of Assignment and Request for Information. There are two kinds of reviews – regular and expedited.
With the regular review, the medical records must be sent within 15 calendar days of the date on the notification or within 12 days of an electronic notification. For an expedited review, the records must be provided within 24 hours. Both the employer and the representative for the employee must get a notification regarding the documents that were submitted and those that were not provided previously.
Although an IMR is designed to avoid court, that does not mean that a worker whose claim is being held up because of a dispute about medical treatment should not have legal assistance. A lawyer who understands workers’ compensation and IMRs should be contacted as soon as any issue arises. This can be useful from the beginning of the claim and throughout the process.
Source: dir.ca.gov, “Independent Medical Review (IMR),” accessed on Jan. 8, 2018