Independent medical reviews (IMRs) are viewed with a lot of mistrust and trepidation by most workers receiving workers’ compensation. The review process is supposed to help resolve disputes over what treatment for an injured worker is actually necessary.
Is that fear really justified?
In theory, the doctor performing the independent review is supposed to be unbiased. He or she is supposed to examine the injured worker, look carefully at the objective medical evidence that’s provided (like X-rays and lab reports) and make his or her decision without regard to the wishes of either the injured employee or the employee’s insurer — who are usually at odds.
In practice, however, the independence of those physicians may be questionable at best. A study done in early 2017 shows that more than 91 percent of denials and modifications of treatment for injured workers are upheld by these so-called “independent” physicians during reviews.
This confirms what many injured workers (and their attorneys) have long suspected or believed. Injured employees are usually steered to specific physicians that work with the employer’s insurer. Once those physicians see an opening to reduce a worker’s treatment plan — or terminate it altogether — asking for an IMR isn’t likely to be helpful.
Many doctors doing IMRs do little more than rubber stamp the decisions made by the treating physicians. In fact, reviews show that the rate at which the treating physicians’ decisions are upheld hasn’t changed since 2014.
The state has recently noted that requests for IMRs have dipped slightly — a little over 2 percent in 2017 over previous years — which is far less than lawmakers believed would happen once the IMR process started in 2012.
Initially, lawmakers thought that IMRs would bring about a big reduction in the number of disputes with workers’ comp doctors about everything from what medication the injured workers should receive to what physical therapy they should be allowed.
The IMRs were supposed to help attorneys and their clients know what services would be approved based on the evidence submitted. In reality, it seems like the IMR process is just another tangle of red tape put in front of injured workers on the road to needed treatments and benefits.
Given the difficulty of getting a reversal via an IMR, injured workers facing a reduction in treatment or a cessation of benefits are wise to seek legal advice.
Source: Insurance Journal, “California Workers’ Comp Medical Review Volume Fell Slightly in 2017,” March 14, 2018