Independent Medical Review, often called IMR, is a process used in California workers’ compensation cases to resolve disputes about medical treatment. When an insurance company denies, delays, or modifies a doctor’s request for treatment, the injured worker may have the right to request an independent review.
The goal of IMR is to determine whether the requested treatment is medically necessary according to California workers’ compensation medical guidelines.
Why Independent Medical Review Is Used
Before medical treatment is approved in a workers’ compensation case, the request must go through a process called utilization review. During utilization review, the insurance company evaluates whether the proposed treatment meets medical necessity standards.
If the treatment is denied, delayed, or changed through utilization review, the injured worker can challenge that decision by requesting Independent Medical Review.
What Types of Decisions Can Be Reviewed
Independent Medical Review focuses specifically on disputes about medical treatment. Examples of issues reviewed through IMR include:
- Denials of surgery or medical procedures
- Requests for physical therapy or rehabilitation
- Approval of diagnostic tests such as MRIs
- Authorization of medications or medical equipment
- Recommendations for specialist care
IMR does not determine disability benefits or other non-medical issues in the claim.
How the IMR Process Works
To begin the process, the injured worker must submit an Independent Medical Review application after receiving a utilization review denial. The request is sent to the Division of Workers’ Compensation.
An independent medical professional who was not involved in the original decision reviews the medical records and treatment request. The reviewer evaluates whether the requested treatment meets the Medical Treatment Utilization Schedule and other recognized medical standards.
After the review is completed, a written decision is issued. The insurance company must follow the determination.
Why IMR Matters for Injured Workers
Medical treatment is a critical part of recovery after a workplace injury. When treatment is denied, the IMR process provides a way for injured workers to have the decision evaluated by an independent medical reviewer.
Although the process focuses strictly on medical necessity, it can determine whether important treatment is approved or denied.
Get Help With Treatment Denials
Treatment disputes can create delays and uncertainty during a workers’ compensation claim. If your medical care has been denied or delayed, it may be possible to challenge that decision through Independent Medical Review.
The Law Offices of Norman J. Homen helps injured workers throughout California navigate treatment disputes and protect their rights within the workers’ compensation system. Contact us today for a free consultation.
Norman J. Homen
Norman Homen is a California attorney with over 30 years of experience representing clients in workers’ compensation and Social Security disability matters.
Recent Posts
Testimonials
Norman J. Homen and Moises Aguirre are very professional. They helped win my case. They communicated very well with me and were very helpful to me. I would recommend this team for your case.
—Joe Prada
We had a good experience with this office . They worked with us and kept us informed with what we needed to know and how process works . My husband had been trying to get approved since 2021 on our own but kept getting denied . Very thankful to this team he finally got awarded!
—Lupe
I am grateful for all of the great people at Law Offices of Norman J. Homen. They won my case and I definitely recommend them. I am Spanish speaking so with the help of Moises Aguirre, I was able to communicate clearly during the whole appeal process and answered any questions I had. Thank you!
—Graciela Villeda
