California Workers’ Compensation and the Independent Medical Review (IMR)
A California workers’ compensation attorney can provide critical support for injured workers who will need medical care for their injuries for months or years into the future. These injury victims often need the help of a seasoned workers’ compensation attorney to ensure that they not only understand how much they can expect to pay in medical expenses related to their injuries over their lifetime but also to help them obtain the settlement they’re owed from insurers. One of the key parts of any workers’ compensation claim is the independent medical review (IMR). Making sure the IMR goes well is vital in securing maximum coverage for a workplace injury.
Our board-certified workers’ compensation attorney at Invictus Law has decades of experience securing compensation for the medical expenses of California workers injured on the job. We will walk you through the IMR process and ensure that you satisfy all appropriate legal and administrative requirements to maximize your benefits. Contact our offices as soon as possible after a workplace injury in Southern California to determine your best course of action.
How Does an IMR Affect My Workers’ Comp Claim?
In California, when an injured employee files a workers’ compensation claim, the California Division of Workers’ Compensation (DWC) receives a request for medical treatment. The DWC will establish a review board to evaluate the claim and decide whether to approve the request. Specifically, the DWC will undertake a “utilization review” (UR) to determine whether the requested treatment is medically necessary. The UR will be conducted by both physicians and non-physicians. If the request for care is deemed medically unnecessary, then the DWC may delay, deny, or modify the treating physician’s request for medical treatment. Whatever the case, if the DWC denies treatment, it will issue a letter to the claimant explaining the decision.
If the worker disagrees with the result of the UR, they can request an independent medical review to challenge the decision. An IMR is a non-judicial process utilized to adjudicate disputes over medical treatments for injured workers. The State of California, through its contracted independent medical review organization, will appoint medical professionals to conduct an IMR.
Who Pays for the IMR?
The DWC will contract with an independent medical review organization to conduct the IMR on its behalf. The costs of the IMR will be covered by an employer who is required by law to provide workers’ compensation protection for employees.
Does the IMR Process Help or Hurt Workers?
The IMR process was established as a way to efficiently and fairly resolve worker disputes over workers’ compensation claim decisions. The process is meant to be faster and easier than a court dispute, making disputes over treatment cheaper and faster to resolve. Unfortunately, in practice, the system has created many problems for injured workers.
The system has tended to lean in favor of insurance providers and against broad coverage for workers who have been hurt on the job. In fact, according to a recent study by the California Workers’ Compensation Institute, over 90% of all IMR cases result in the original UR denials being upheld. Workers are, however, entitled to have an attorney help with all aspects of their workers’ compensation claim, including the IMR process. To maximize your chances of securing coverage for medical treatments after a workplace accident, make sure you retain an experienced and dedicated workers’ comp attorney for assistance.
Southern California Workers’ Compensation Lawyer
If you need educated and effective legal help with a claim for workers’ compensation benefits in southern California, contact the Orange County and Inland Empire offices of Invictus Law for a free consultation at 949-287-5711.