Independent Medical Review (IMR) Update 2025, Q2

Case Decisions

Month Total Issued Average Age from
Assigned Date
(in days)
Average Age from
Complete Medical
Records (in days)
January 13,619 32 8
February 12,364 27 8
March 12,410 25 6
April 12,859 25 6
May 12,480 25 7
June 11,908 25 7
July      
August      
September      
October      
November      
December      
Total 75,640 - -

"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 16,557 15,926 16,784 17,165 16,552 16,518             99,502
Total Number of Unique Applications 13,601 13,013 13,871 14,260 13,643 13,829             82,217
Total Number of Eligible Applications 12,256 11,924 12,723 13,036 12,470 12,766             75,175

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) 3,484
No Signature 470
No Signature & No UR 34
No UR Attached 1,113
Untimely 1,400
Other 541
Total 7,042

**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 110 95% 5%
BEHAVIORAL AND MENTAL HEALTH SERVICES 2215 81% 19%
Evaluation & Management
520 81% 19%
Therapies
1695 81% 19%
DIAGNOSTIC TESTING 15666 86% 14%
EMG/NCV/NCS
1887 89% 11%
Imaging, Radiology
9925 87% 13%
Lab & Pathology
2876 84% 16%
Other Diagnostic Tests
978 81% 19%
* DMEPOS 13327 89% 11%
Durable Medical Equipment
4457 94% 6%
Electrical Stimulation
3073 88% 12%
Prosthetics / Orthotics
2712 87% 13%
Supplies
3085 87% 13%
Other
0    
EVALUATION & MANAGEMENT 6153 82% 18%
Dental Services
376 75% 25%
Evaluation & Management
842 77% 23%
Medical Specialties
4935 84% 16%
HOME HEALTH 888 90% 10%
INJECTIONS 12521 93% 7%
Spine
7 86% 14%
Peripheral
6881 92% 8%
Other Injection
5633 95% 5%
PHARMACEUTICALS 41035 91% 9%
Antidepressants 7889 94% 6%
Anti-Epilepsy Drugs 3702 92% 8%
Anti-Infectives 1168 78% 22%
Benzodiazepines 690 95% 5%
Laxative 449 95% 5%
Muscle Relaxants 782 87% 13%
NSAIDs 4915 79% 21%
Opioids 9050 93% 7%
Sedative / Hypnotics 884 96% 4%
Topical Analgesics 6381 99% 1%
Other Pharmaceuticals 5125 84% 16%
PROGRAMS 1930 82% 18%
REHABILIATION 30001 91% 9%
Acupuncture
5780 94% 6%
Chiropractic
3312 90% 10%
Other Therapies
4697 91% 9%
Physical Therapy / Occupational Therapy
16212 90% 10%
SURGERY 9080 89% 11%
Adjunct Surgical Services
3468 92% 8%
Arthroscopic Surgery
1512 83% 17%
Non-arthroscopic Surgery
3225 88% 12%
Surgical Consult
875 90% 10%
TRANSPORTATION 429 96% 4%

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

July 2025