DIR, DWC Releases Independent Medical Review (IMR) Report for 2024
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 2024, the twelfth year since the program was implemented.
The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 199,651 IMR applications, and issued 141,621 Final Determination Letters, each addressing one or more medical necessity disputes. Throughout the year, the IMRO issued decisions, on average, six to seven days after receipt of all medical records.
Some highlights of the report are as follows:
- Nearly 90% of all unique IMR filings were deemed eligible for review, slightly less than the annual percentage for those filed in 2023.
- Pharmaceutical requests accounted for 33% of all treatment requests sent for IMR, a slightly higher proportion of total service requests than in previous years.
- Opioids comprised 24% of all pharmaceutical requests.
- Treatment request denials were overturned at an overall rate of 12.7%, an increase from the previous year (10.2%). The denials that were overturned most often were for evaluation and management services, followed by other programs such as Functional Restoration program, Brain Injury program, Weight loss program, and behavioral and mental health service.
- 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.