Workers who face denials when filing for workers’ compensation benefits may feel discouraged. Fortunately, California offers an Independent Medical Review program that enables employees to contest these decisions.
Reviewing the independent medical review (IMR) process can help injured workers navigate the complex process of receiving workers’ compensation.
How IMRs work
The IMR process involves an independent panel of medical professionals who assess and make decisions on the necessity of medical treatments. Unlike the time-consuming and costly route of going to court, IMR offers a faster alternative.
Independent Medical Review becomes relevant when a worker requests workers’ compensation. This request initially undergoes a thorough review. If the first review results in a denial or change to the treatment plan, the injured worker has the right to request an IMR. Independent Medical Review Organizations conduct these reviews, ensuring a fair assessment. In California, the employer must cover the cost of an employee’s IMR.
Initiating an IMR
For a successful IMR, claims administrators should provide workers with proper documentation. Injured workers must include the decision letter along with their signed application and send it within 30 days. The application must also include the Workers’ Compensation Information System number. In cases involving liability disputes, IMR is not available until the involved parties resolve the conflict.
Maximus Federal Services manages all IMRs in California. Upon confirming eligibility, Maximus sends a Notice of Assignment and Request for Information to all involved parties within a day. Individuals can send medical records through MOVEit, safeguarding the confidentiality of sensitive information. For regular reviews, individuals must submit medical records within 15 days. Expedited reviews require records within 24 hours.
IMR is a streamlined process that can help injured employees settle disputes within California’s workers’ compensation system.