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Independent medical reviews fall in Calif. during COVID-19 lockdown

Posted On: Sep. 21, 2020 1:47 PM CST

medical reviews

Independent medical reviews of workers compensation claims in California dropped nearly 18% in the first half of 2020 compared with the same time in 2019, according to a bulletin released Friday by the California Workers Compensation Institute.

Under California law, every workers comp claims administrator must have a utilization review program to ensure workers are receiving evidence-based medical care. Workers may contest declined treatment requests by requesting an independent medical review.

From January through July 2020, CWCI found that 70,000 IMR decision letters had been issued, compared with 85,000 in the first half of 2019. The biggest declines in IMR decisions occurred in May and June when much of California still had shelter-in-place orders, according to the CWCI.

However, outcomes of those letters remained largely the same, with 89% of IMR doctors upholding the utilization review decision in 2020, compared with 88% in 2019. About 40% of letters included decisions on multiple services in 2020.

The bulletin also noted that prescription drug challenges accounted for nearly 40% of all IMR decisions in the first part of 2020, with opioids accounting for 29%, which is down slightly from opioids accounting for 31% of drug-related IMR decisions in 2019.

More insurance and workers compensation news on the coronavirus crisis here.