Drug reviews accounted for more than one-third of all California's independent medical review activity in 2019, according to a report released Friday by the California Department of Industrial Relations.
In 2012, the government signed Jerry Brown in legislation. create an independent medical review program, which entered into force on 1 January 2013. The IMR program is available to all injured workers regardless of the date of injury and is intended to expedite the resolution of workers' compensation disputes. IMR reviewers follow guidance from the schedule for the use of medical treatment and evidence-based medicine in their determinations, and employers bore the cost of the program.
According to California DIR data, the state processed more than 222,200 IMR, a decrease of about 1
Approximately 10.4% of treatment requests were rejected in the IMR program – with the examiner's conclusion that the treatment was medically necessary and appropriate – and special consultation, office visits and mental health services were among the most common questions.
Inquiries with first reverse usage review denials included reviews of durable medical equipment, prostheses, orthoses and supplies, and home health care and transportation.
Drug inquiries accounted for about 36% of all IMR requests, down from 40% in recent years, with opioids involved in almost a third of these pharmaceutical review cases. DIR said that the reduction can be attributed to the preparation of a drug form 2018.