Workers’ compensation benefits are supposed to help you after an injury on the job. Unfortunately, insurers may try to deny benefits to benefit their bottom line, and that of your employer. Independent medical reviews (IMRs) use a neutral physician to evaluate whether your requested treatment is medically necessary. Their evaluation can have a significant impact on your case, especially if they find against you. Reviews of these decisions are on the rise, but there is more you need to know.
At Ratto Law Firm, P.C., our California workers’ compensation attorneys know how independent medical reviews after your claim and how we can help. Schedule your meeting today to learn more.
What Are Independent Medical Reviews (IMRs)?
- Definition: IMRs occur when a worker challenges a denial or modification of medical treatment by a Utilization Review (UR) physician.
- Process: The dispute is submitted to the state, and an independent doctor reviews the case.
- Outcome: The IMR decision is binding, meaning it determines whether the treatment will be authorized.
The Numbers Behind the Rise
According to the California Workers’ Compensation Institute (CWCI):
- IMR decision letters declined steadily from 2018 through 2022.
- Starting in 2023, the number of IMRs began to climb again, continuing through 2024 and the first quarter of 2025.
- Over 1.57 million IMR decision letters have been issued since 2015.
- The uphold rate (denials or modifications that were confirmed) remains close to 90%.
The thing is, while medical challenges are on the rise, most IMRs still side with the original decision. However, the right attorney can help you navigate this.
Why IMRs Are Increasing Again
Several factors explain the rise:
- More Medical Disputes: As treatment costs rise, insurers are more likely to deny or modify requests.
- Worker Awareness: Injured employees are increasingly aware of their right to challenge denials.
- System Adjustments: Legislative and administrative changes have streamlined the IMR process, making it easier to file disputes.
What This Means for Injured Workers
- Challenging Denials Is Common, But Success Is Rare
- With a 90% uphold rate, most IMRs confirm the insurer’s denial.
- Workers should prepare strong medical evidence before filing.
- Treatment Delays Are Likely
- The IMR process takes time, which can delay access to care.
- Injured workers should anticipate waiting periods and plan accordingly.
- Documentation Is Critical
- Detailed medical records and physician support increase the chances of success.
- Workers should ensure their doctors provide thorough justification for requested treatments.
- Legal Guidance Helps
- Workers’ compensation attorneys can help navigate the IMR process.
- Professional guidance may improve the odds of overturning a denial.
How Does This Affect Me or My Employer?
- For Workers: While IMRs provide a path to challenge denials, the high uphold rate means frustration and delays are common.
- For Employers/Insurers: Rising IMR filings increase administrative costs and highlight ongoing disputes in the system.
- For the System: The surge in IMRs suggests ongoing tension between cost control and adequate medical care.
Better Understand the Rise in Independent Medical Reviews and How It May Impact Your Case
Even though independent medical reviews are on the rise, they still tend to side with the original decision and with the insurer. This can make it a challenge for employees seeking the benefits they’re entitled to. However, you don’t have to do it alone. The right workers’ compensation attorney in California can give you personalized help.
Our team at Ratto Law Firm, P.C. provides you with the advice and representation you need. Contact us today for a consultation.