People who are injured while working will usually be able to receive workers' compensation benefits, which will address issues such as the costs of their medical treatment, the income lost while recovering from an injury, and job displacement. However, the process of obtaining workers’ comp benefits is not always straightforward. In some cases, disagreements may arise between an injured worker and their employer or an insurance provider over the medical treatments a person should receive. In such cases, independent medical reviews (IMRs) may be used by the California Division of Workers’ Compensation (DWC) to help resolve these disagreements.
What Is an Independent Medical Review?
An independent medical review is a process that is used to resolve disagreements between injured workers and workers' compensation insurance companies about the treatments that should be provided and whether certain treatments are medically necessary. In an IMR, a medical professional will review a request for treatment and medical records and documentation about a patient's condition and provide an opinion on whether the requested care is medically necessary.
How Does the IMR Process Work?
If a disagreement over medical treatment arises, a utilization review (UR) may be performed to determine whether treatment is medically necessary. If medical treatment is denied or modified following a utilization review, the injured employee can request an independent medical review. An application for an independent medical review must be submitted within 30 days after the injured worker received a written utilization review determination.
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