Independent Medical Review (IMR) decisions

The Independent Medical Review (IMR) program was created as part of Senate Bill (SB) 863’s important overhaul of the California workers’ compensation system.

The IMR program provides an expedient method to resolve medical necessity treatment disputes for all dates of work-related injury. The DWC has contracted with an independent medical review organization (IMRO) to conduct IMR on its behalf.

Each IMR case pertains to one or more requested treatments that were denied, delayed or modified following utilization review (UR). The IMRO’s expert reviewers use evidence-based guidelines contained in the DWC Medical Treatment Utilization Schedule (MTUS) to determine whether to uphold or overturn the UR decision. The rationale for a reviewer’s decision for each requested treatment is provided in the IMR final determination letter. Please visit the MTUS page for more information on evidence-based medicine.

All IMR decisions since the program began on Jan. 1, 2013 are posted on DWC’s website after being issued. IMR decisions that were withdrawn or determined to be ineligible are not posted. The DWC IMR search tool allows users to easily research the database of IMR decisions.

 

 

May 2016