In 2017 the number of California’s Independent Medical Reviews (IMR) dropped slightly for the first time ever since being adopted in 2012. The California Workers’ Compensation Institute (CWCI) did an analysis on IMR decisions issued between 2014 and 2017 and data shows that the volume of IMR decisions fell but the outcomes (upheld, modified or denied services) stayed the same.

When a UR physician modifies or denies a request for a medical service, a worker can submit an application for an IMR.

The institute reviewed 648,450 IMR decisions issued between 2014 and 2017. The data shows 3,808 fewer cases in 2017 than in 2016, or a 2.2 percent decline in IMR services. IMR physicians upheld 91.2 percent of modified or denied service requests that they received, a number that remains unchanged since 2016. Prescription drug requests counted for the largest portion of IMR requests at 46 percent (29.1 percent were requests for opioids). Compound drug requests fell from 6.5 percent in 2016 to 4.2 percent in 2017, and IMR physicians have denied them in 99 percent of their cases. A request for evaluation and management services (typically a referral for consultation) was the medical service category most likely to be overturned by IMR with an uphold rate of 79.2 percent.

In a consistent trend, the top ten percent of physicians named in IMR letters accounted for 85 percent of disputed requests. Los Angeles and the Bay Area still maintained a disproportionately high portion of IMR cases compared to more rural areas.

When the IMR process was initially adopted lawmakers thought the doctors, attorneys, and those involved in the process would start to learn which services could be approved based on evidence-based standards and that over time this system would reduce disputes. This is the first time since the process was adopted that volume has decreased.

Read the press release from CWCI.