The California Workers’ Compensation Institute reported that after reaching a new low in 2021, the volume of independent medical review decisions continued to decline in the first half of this year.
SB 863 2013 created the IMR administrative process to resolve disputes over treatment requests without involving judges. Lawmakers anticipated that IMR volume would decline as providers became familiar with the treatment guidelines, but it wasn’t until 2019 that volume dropped sharply, falling 11.3% to a 5-year low of 163,899, with annual letter volume declining thereafter another 16.6% to 136,738 in 2020 (the first year of the pandemic), followed by a 2.4% drop to 133,494 letters in 2021, the CWCI said in a bulletin released Wednesday.
The decline continued in the first half of this year as the number of letters fell by 7.6% from the previous year to a record low of 62,859.
CWCI said that IMR decisions may include decisions on multiple disputed treatments, but the number of service decisions is also decreasing.
In 2019, IMR doctors made decisions on 261,708 service requests. The number fell by 17.5% to 215,788 disputed treatments in 2020 and fell again to 209,782 in 2021. In the first half of this year, there were 97,649 decisions on primary care requests.
Disputes about medicines decreased from 47.3% of all IMRs in 2017 to 34.9% in 2021 and 33.9% of IMR decisions in the first half of this year.
WorkCompCentral is a sister magazine to Business Insurance. More stories here.