Independent Medical Review (IMR) is a process used to settle disagreements about medical treatment for injured workers. If utilization review (UR) denies, delays or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, the injured worker can ask for a review of that decision through IMR. (For information on UR, please refer to our article entitled My adjuster said my surgery was denied by UR. What's UR?).
The employer/insurance company pays for this review. There is no cost to the injured worker. The State selects the organization that performs the IMR, and that company is currently Maximus. The IMR doctor is anonymous, and in theory this helps to get an independent and fair review and determination.
When the adjuster sends you a notice telling you that UR denied, delayed, or modified your treating doctor’s request for medical treatment, the adjuster is required to send you a copy of the UR decision letter along with a pre-completed IMR form for you to sign and submit to the review organization. You will need to sign the IMR application and send it along with a copy of the UR decision letter to the address on the form within thirty (30) days of receiving the UR decision letter.
As of July 1, 2013, all dates of injury are eligible for IMR to address treatment disputes.
If you have questions about your workers' compensation injury and want to talk to an attorney in Fresno, please call 559-408-7436 or fill out the form to the right.
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