Independent medical reviews decline in 2020

The request for independent medical review of workers compensation disputes in California declined in 2020 but nearly 94% of filings were deemed eligible for review, the highest percentage since IMR began, according to research released Wednesday by the California Department of Industrial Relations.

The state implemented the IMR system as part of 2012 workers compensation reforms.

In 2020, the state’s Independent Medical Review Organizations processed 184,000 IMR applications, a 17% decrease from the prior year, but the drop was most significant in the earlier part of 2020 due to the COVID-19 pandemic and application figures rebounded in the second half of the year, the report noted.

IMRs in 2020 overturned approximately 9.5% of utilization review decisions that denied treatment requests made by physicians, which is slightly less than 2019’s overturn rate of 10.4%.

More than a third of all IMR requests were disputes involving pharmaceutical requests, and of those, 30% were related to opioid requests. IMR requests for diagnostic tests represented 18% of all issues, followed by rehabilitation services at 17%.

Denials that were overturned most often were for behavioral and mental health services (18%), followed by functional restoration and gym memberships (16%) and specialist consultation and dental services (15%).