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California comp medical review volume falls to record low


The total number of independent medical review determination letters in California fell to an all-time low in 2020, according to a new report by the California Workers’ Compensation Institute.

“With statewide unemployment remaining stubbornly high, millions of Californians still working remotely and the volume of non-COVID workers’ comp claims and medical services holding below pre-pandemic levels, the number of independent medical reviews used to resolve California workers’ compensation treatment disputes continued to decline in the first half of 2021,” CWCI said in a Bulletin published Friday.

CWCI reported that 136,738 IMR decision letters were issued last year, down 16.6% from 163,899 in 2019 and 26% below the record 185,735 letters issued in 2018.

Even with the formulary and other changes to treatment guidelines, disputes over opioids still accounted for 25.8% of pharmaceutical cases in the first half of this year, more than any other class of drugs. Musculoskeletal therapy drugs accounted for the second-largest share at 17.8%, and dermatological drugs ranked third at 16.3%.

Despite the overall decrease, prescription drug requests still account for more IMRs than any other type of medical service, according to CWCI. Physical therapy comes in a distant second, accounting for 13.3% of disputed treatments in the first half of this year and injections at 12%.

Durable medical equipment, prosthetics, orthotics and supplies accounted for 9.7% of IMR determinations in the first half. No other category accounted for more than 5% of the IMRs during this period.

WorkCompCentral is a sister publication of Business Insurance. More stories here.