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About 90% of medical review decisions upheld in Calif.

medical review

Treatment request denials in California’s workers compensation system were overturned at a rate of 10.3%, with specialist consultations, office visits and mental health services overturned most often, according to a report released Tuesday by the Department of Industrial Relations and its Division of Workers’ Compensation.

In 2018, the department received 252,565 applications into its medical dispute resolution process, which was put in place with state reforms in 2013 and aims to give comp stakeholders and injured workers a way to use medical expertise to obtain “consistent, evidence-based decisions on treatment,” according to the report. The number of applications has remained flat over the past for years, the report shows.

In 2017, 8.3% of treatment requests were overturned, according to the report.

The monthly average length of time to issue an IMR determination after receipt of all medical records had decreased to an all-time low of nine days toward the end of 2018, down from 14 days — a high seen twice in two months in the past two years, according to the report.

Meanwhile, more than 41.7% of treatment requests sent for IMR were for pharmaceuticals, with opioids comprising nearly one of every three pharmaceutical requests, according to the report, which did not provide 2017 figures.





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