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Examining California’s Workers Compensation System

Since 2013, California’s Worker’s Compensation system has utilized a system of Independent Medical Review (“IMR”) to resolve disputes over the treatment of workers injured on the job. Typically, in California’s system, a request by an injured worker for medical treatment must undergo a “utilization review” (“UR”) process to determine whether the requested treatment is medically necessary to the worker. When a medical provider’s request for treatment is modified or denied as not medically necessary, rather than going through the court system to resolve the dispute, the injured employee can request the decision be reviewed through the IMR system.

The cost of the IMR is borne by the employer and is based upon the individual dispute and the number of physicians needed to resolve the dispute. When the IMR system was passed into law, it was touted as being more efficient and substantially more cost-effective than the system in place at that time. In 2014, a report by the California Labor and Workforce Development Agency, Department of Industrial Relations, Division of Worker’s Compensation found that “[i]n its first year, the DWC IMR program issued a total of 3,723decisions and overturned 16% of UR decisions. In contrast the DMHC IMR program for group health, non-work related medical conditions, on which the DWC program was based, reviewed only 7,483 medical cases over ten years (2001-2010), overturning 36% and 50% of UR decisions.” 2014 IMR Annual Report

In 2015, the California Workers Compensation Institute issued a study of the IMR system and found that IMR decisions upheld UR doctor’s denials or modifications 88.6% of the time. However, the Inland Empire, San Diego County, and Orange County IMR decisions were lower than in Los Angeles CountyCWCI Study Spotlights California Workers’ Comp 2015 Independent Medical Review Outcomes, Feb. 18, 2016

If you have a pending worker’s compensation issue, call Michael Leonard, Esq. of San Diego Corporate Law to be pointed in the right direction. To schedule a consultation with Mr. Leonard to discuss your incorporation needs, or any other business-related matter, you can visit San Diego Corporate Law or call (858) 483-9200.

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