1. DWC

Independent Medical Review (IMR) Update 2024

Case Decisions

Month Total Issued Average Age from
Assigned Date
(in days)		 Average Age from
Complete Medical
Records (in days)
January 11,589 27 7
February 10,926 24 6
March 11,450 24 6
April 12,142 24 6
May 11,368 25 6
June 9,840 28 6
July 12,464 28 6
August 12,756 30 6
September 13,330 30 8
October 12,279 27 6
November 10,817 28 7
December 12,661 31 8
Total 141,622 - -

"Average Age from Assigned Date" represents the average number of calendar days required to process an IMR from the date the Notice of Assignment and Request for Information (NOARFI) was mailed to the date the Final Determination Letter (FDL) was mailed.

"Average Age from Complete Medical Records" represents the average number of calendar days required to process an IMR from the date MAXIMUS received all necessary records to the date the FDL was mailed.

IMR Applications

Jan Feb Mar
 Apr May Jun Jul 
 Aug Sep Oct Nov Dec Total
Total Number of IMR Applications Received 15,032 15,354 16,063 16,778 17,305

15,964

 17,941 17,277 16,443 18,760 16,136 16,595 199,648
Total Number of Unique Applications 12,477 12,750 13,325 13,760 14,296 13,097 14,709 14,090 13,558 15,378 13,216 13,599 164,255
Total Number of Eligible Applications 11,228 11,646 12,146 12,400 12,859 11,793 13,215 12,572 12,130 13,828 12,021 12,454 148,292

Total IMR Applications are the gross number received by the IMRO in the given calendar month. Once duplicate filings have been identified and removed, those Unique Applications are screened for eligibility.

IMR Ineligible Applications

Eligible Applications are those accepted by the IMRO for review. Reasons for applications being found ineligible include: 

  • It lacks the signature of the injured worker (or representative);
  • It is not on time, that is, not submitted within 30 days of receipt of the UR decision;
  • The utilization review report is not attached to the application; or
  • The utilization review is invalid because it contains a conditionally noncertified (CNC)** decision.
Reason Total Count
Conditionally Non-Certified (CNC) 8,394
No Signature 1,133
No Signature & No UR 90
No UR Attached 2,808
Untimely 2,355
Other 1,183
Total 15,963

**Conditionally noncertified (CNC) decision: A UR decision that has been denied because the treating physician has not provided the medical information requested by the claims administrator that is required to make a medical necessity determination on the treatment recommendation.

Treatment Requests and Outcomes

“Treatment request” refers to the medical treatment that was denied in UR and challenged through the IMR process. IMR cases have at least one treatment, or may have more than one. Treatment requests are classified into broad categories and subcategories; specific detail is found in the Final Determination Letter.

  • Uphold – the IMRO decided that the disputed service was not medically necessary and appropriate.
  • Overturn – the IMRO decided that the disputed service is medically necessary and appropriate.

Category/Subcategory Number of
Decisions		 UR
Upheld		 UR
Overturned
ACCOMMODATION 211 89% 11%
BEHAVIORAL AND MENTAL HEALTH SERVICES 4410 80% 20%
Evaluation & Management
 977 77% 23%
Therapies
 3433 81% 19%
DIAGNOSTIC TESTING 28843 82% 18%
EMG/NCV/NCS
 3595 85% 15%
Imaging, Radiology
 17648 84% 16%
Lab & Pathology
 5779 79% 21%
Other Diagnostic Tests
 1821 75% 25%
* DMEPOS 23902 89% 11%
Durable Medical Equipment
 7887 92% 8%
Electrical Stimulation
 5979 91% 9%
Prosthetics / Orthotics
 4878 85% 15%
Supplies
 5156 84% 16%
Other
 2 100% 0%
EVALUATION & MANAGEMENT 11197 77% 23%
Dental Services
 801 63% 37%
Evaluation & Management
 1579 77% 23%
Medical Specialties
 8817 78% 22%
HOME HEALTH 1501 87% 13%
INJECTIONS 22420 91% 9%
Spine
 10 90% 10%
Peripheral
 11976 90% 10%
Other Injection
 10434 92% 8%
PHARMACEUTICALS 81236 89% 11%
Antidepressants 14170 93% 7%
Anti-Epilepsy Drugs 7297 90% 10%
Anti-Infectives 2304 73% 27%
Benzodiazepines 1408 94% 6%
Laxative 995 93% 7%
Muscle Relaxants 1381 79% 21%
NSAIDs 8881 77% 23%
Opioids 19427 91% 9%
Sedative / Hypnotics 1930 92% 8%
Topical Analgesics 13247 97% 3%
Other Pharmaceuticals 10196 81% 19%
PROGRAMS 3714 78% 22%
REHABILIATION 53549 90% 10%
Acupuncture
 10304 93% 7%
Chiropractic
 5888 90% 10%
Other Therapies
 8033 90% 10%
Physical Therapy / Occupational Therapy
 29324 89% 11%
SURGERY 17037 84% 16%
Adjunct Surgical Services
 6398 88% 12%
Arthroscopic Surgery
 3239 79% 21%
Non-arthroscopic Surgery
 5804 83% 17%
Surgical Consult
 1596 85% 15%
TRANSPORTATION 699 94% 6%

*DMEPOS: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

January 2025