I’ve received Independent Medical Review paperwork. What is this?
An Independent Medical Review (IMR) is the appeal that may be requested if an employee's medical care is denied, delayed or modified by the Utilization Review (UR). IMR is ‘designed’ to be a more efficient and less expensive way of resolving disputes than directly going through the court system. (http://www.dir.ca.gov/dwc/IMR.htm)
Think of an IMR as a Utilization Review, part 2. During this process, a doctor that has not previously examined the injured worker either upholds or overturns the insurance carrier’s earlier denial, delay or modification of medical treatment. The doctor also has limited access to medical records from the worker and therefore can treat the situation as an isolated, or "independent," incident.
Be forewarned, IMR has a 95% rate of upholding UR denials. It is very difficult to reverse a decision unless you can find some sort of deficiency with the original UR non-certification. If you have received IMR paperwork, it is best to contact our office to discuss how to proceed. There are strict timeframes applicable to filing an IMR, which means that requesting an appeal must be done promptly and correctly. The professional attorneys at The Law Office of Gerald D. Brody are available to answer your questions or concerns regarding IMRs.