DIR, DWC Release Independent Medical Review Progress Report for 2020
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 about the medical treatment of injured workers. The report describes IMR program activity in 2020, the eighth year since the program was implemented.
The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 184,100 IMR applications, and issued 136,740 Final Determination Letters, each addressing one or more medical necessity disputes. In the first half of 2020, IMR program activity slowed with the emergence of the pandemic, but rebounded in the second half. Throughout the year, the IMRO issued decisions, on average, eight to 12 days after receipt of all medical records.
Some highlights of the report:
- Nearly 94% of all unique IMR filings were deemed eligible for review, the highest annual percentage since IMR began.
- Pharmaceutical requests accounted for 34% of all treatment requests sent for IMR, a smaller proportion of total service requests than in previous years.
- Opioids comprised three out of 10 pharmaceutical requests.
- Treatment request denials were overturned at a rate of 9.5%. Specialist consultants, office visits and mental health services were overturned most often.
- Guidelines contained in the Medical Treatment Utilization Schedule continue to serve as the primary resource for the determination of medical necessity.
The progress report is posted on the DIR website.