The California Workers’ Compensation Institute (CWCI) released an analysis showing that the number of independent medical reviews (IMRs) used to resolve workers’ comp medical disputes in the state rose 4.4 percent in the first half of 2018 compared to the first half of 2017. Though even though the amount of IMRs rose, in over 90 percent of those cases physicians performing the IMR upheld the utilization review (UR) physician’s treatment modification or denial.

Changes to the state’s system in 2012 allowed injured workers to request IMRs when their treatment requests were denied or modified by a UR physician. In the first half of 2018 there were 89,873 IMR decision letters issued which represented a 4.4 percent increase from the previous year. Though the average number of primary treatment decisions did not change – 1.8 decisions. Outcomes also did not change all that much. The first half of 2017 saw a 91.2 percent uphold rate (IMR doctors upheld the UR modification or denial) and 2018 saw a 90.7 rate for the first half of the year. Prescription drug requests represented the majority of IMR decisions in 2018 as they did in 2017, 32.3 percent versus 29.7 percent in 2017.

The data also shows that a small portion of physicians account for most of the disputed medical services that go through IMR. The top 10 percent of physicians identified in IMR decisions letters issued in the first half of 2018 (1,190) accounted for 86 percent of disputed services requests in that time. The top 1 percent (119) accounted for 44 percent of disputed services.

David Lanier, secretary of the California Labor and Workforce Development Agency, said that the implementation of IMR decisions helped contribute to the significant cost savings seen in the state’s workers’ compensation system since 2012. Dispute resolutions used to take 9 to 12 months on average, but he says now it’s more like 9 to 12 days.

Read the release from the CWCI.