The Medical Care Dispute Resolution Process through California’s Independent Medical Review (IMR)
When you’ve been injured on the job and filed a workers’ compensation claim but were denied medical care by your employer, the State of California requires the workers’ compensation system to proceed to an Independent Medical Review (IMR) to resolve such employer-employee disputes. The IMR was designed to resolve workplace injury medical treatment disagreements without going through costly and lengthy court proceedings. If after the IMR, the employee’s medical treatment is denied or delayed, the injured employee is entitled to request a review of the IMR’s decision.
However, since IMR was implemented in 2013, it has proven to be as legally complicated, costly and time-consuming as courtroom litigation in many cases. While intended to make it less difficult for injured workers, many believe it has made settling workers’ compensation medical disputes even more challenging.
When you’ve been injured because of a workplace accident, you are legally entitled to medical care and may be in for a battle when your request is denied. That’s where an IMR can assist. If the employee’s medical treatment is denied in whole or part or delayed, the injured employee is entitled to request a review of the IMR’s decision.
Helping California’s Injured Workers® Melissa J. Lyons Represents Injured Workers in Riverside, San Bernardino, and Los Angeles
IMR Confusion – Utilization Reviews and Independent Medical Review Organizations
What does it all mean, and why is it so confusing? To begin the process, when an injured California employee files a workers’ compensation claim for medical treatment, their request must go through a Utilization Review (UR). All California employers and their workers’ compensation carriers are required by law to have a UR program which is used by claims administrators to decide if proposed medical treatment is necessary for an injured employee.
If the UR results in a denial or delay of your medical treatment, it’s critical that one or more objective, independent medical experts be commissioned to objectively decide the legitimacy of your claimed needs. That’s when an Independent Medical Review Organization (IMRO) must step in.
To resolve an employee’s medical treatment claim dispute, the California Department of Workers’ Compensation is required by law to contract one or more IMROs to review your need for medical care. Obviously, allowing your employer or their workers’ compensation insurance carrier to decide whether you should receive medical treatment that they will be required to pay for is unwise since they have a vested financial interest in denying your request for your lawful benefits.
What is an Independent Medical Review Organization (IMRO)?
In California, the Department of Industrial Relations administrative director has designated Maximus as the states IMRO. Maximus, a leading provider of independent reviews of health care appeals worldwide, is responsible for contracting with qualified medical providers to perform IMRs. Within the health care industry, IMROs are a “third-party medical review resource that provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence.” Under California’s Maximus contract, their professionals provide independent medical reviews conducted by an experienced team of physicians, nurses, physical therapists, health appeals specialists and various other professional health clinicians of denied authorization requests or payments for medical services.
Focusing on Your Recovery Should Be the Priority, Not the Complications of an IMR
The last thing you need when you should be focusing on your recovery is trying to make sense of lengthy and detailed legalities of an IMR that will probably make no sense to you. Even some experienced attorneys are challenged by the workers’ compensation system and IMR process. But not the legal team of Workers’ Compensation Lawyers, Inc.
Workers’ Compensation Lawyers, Inc. is A Legal Firm Experienced in Unraveling the IMR Confusion When Employee Cases Have Been Denied or Delayed
As an employee injured on the job who needs guidance through the complexities of workers’ compensation disputes, attorney Melissa J. Lyons has the experience and knowledge to help you through the process. Whether you’ve already filed a claim, or your claim has been disputed or delayed, as attorney Lyons’ client, you will always be treated with respect, understanding and compassion as she works towards a favorable resolution.
Vigilant, Dedicated Attorney “Helping California’s Injured Workers®” is Here to Remove Confusion at No Up-front Cost to You
After attorney Melissa J. Lyons assesses your unique situation, if she determines she may be able to help you, she won’t charge you a cent up-front. Only if she successfully wins your case will she be paid a percentage of your benefits settlement, typically 15% of the total. And it never comes out of your pocket—the court handles attorney fees.
Attorney Melissa Lyons Respectfully and Vigilantly Fights for Employee Workers’ Compensation Benefits in Riverside, Corona, and Los Angeles.
It’s Time to Take Action, End the Confusion and Assert Your Rights—Call Workers’ Compensation Lawyers, Inc. Today
If you’re ready for someone to take on your Riverside, Corona, or Los Angeles workers’ compensation battle (and you probably are, or you wouldn’t be reading this page), call (888) 542-8868 to schedule a free case evaluation.
Of course, any workers’ compensation attorney can make these claims. To gain confidence in a decision to hire Workers’ Compensation Lawyer, Inc.’s legal team, check out our former clients’ testimonials from from yelp.com, avvo.com. and BBB.org.