DIR, DWC Release Independent Medical Review (IMR) Report for 2023 Data
The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted an annual report on the Department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process for the state’s workers’ compensation system that resolves disputes over medical treatment for injured workers. The report describes IMR program activity in 2023, the tenth year since the program was implemented.
The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 175,027 IMR applications, and issued 130,774 Final Determination Letters, each addressing one or more medical necessity disputes. Throughout the year, the IMRO issued decisions, on average, eight to nine days after receipt of all medical records.
Some highlights of the report are as follows:
- Nearly 92% of all unique IMR filings were deemed eligible for review, slightly less than the annual percentage for those filed in 2022.
- Pharmaceutical requests accounted for 31% of all treatment requests sent for IMR, a slightly higher proportion of total service requests than in previous years.
- Opioids comprised 26% of all pharmaceutical requests.
- Treatment request denials were overturned at an overall rate of 10.2%. Behavior and Mental Health Services, Evaluation and Management, Programs (such as Functional Restoration) were overturned the most often.
- Guidelines contained in the Medical Treatment Utilization Schedule continue to serve as the primary resource for the determination of medical necessity.
The report is posted on the DIR website.