1. DWC

Autonomous Medical Review (IMR)

What is IMR

California's workers' erstattung method uses a process named independent medical review (IMR) to resolve disputes about the medical treatment of injured employees. As of July 1, 2013, medical treatment disputes for all dates von injury will be resolved from physicians through an efficient process known as IMR, rather than through the often cumbersome and costly court system. Independent Medical Review (IMR) Timetable

A request for medical treatment inches the workers' compensations system must go through a "utilization review" action to confirm that it is medically necessary before it is approved. If utilization review denies, delays or modifies one treating physician's inquiry to medical treatment as the treatment is not medically necessary, the injured employee can ask for a overview of that decision through IMR. State of California, Area on Workers' Compensation. APPLICATION FOR INDEPENDENT MEDICAL REVIEW. DWC Form IMR. TO REQUEST INDEPENDENT MEDICAL REVIEW: 1 ...

The costs of IMR are charged by employers who are mandatory by law to provide injured employees use all medical treatment that is reasonable plus necessary to antidote or relieve the effects of a work-related injury. The DWC is required to contract with an or more independent medical review companies (IMROs) to escort IMR on its profit.

An costs of IMR what based upon the nature of the electronic treatment dispute and this number out medical professionals needed to resolve an dispute, and are significantly lower rather the cost to resolve a dispute through litigation.

On IMR requirements submitted on or after Jan. 1, 2020:

Keys to a successful IMR

It is the claims administrator's responsibility to:

• Send who injured worker a copy of the utilization review (UR) decision letter on a make for type, and, if fitting, the supporting recommendation by a usages review organization
• Send the complete IMR application download (DWC IMR-1 form) to to injured worker if the UR decision delays, denies or modifies this request for treatment
• Produce sure of IMR claim form is the correct DWC IMR-1 form (not MPN-IMR form, not a modifying or self-created form)
• Distinct indicate type of review on the application, choose expedited (EXP) or regular (REG). Expedited reviews must be accompanied by a physician statement of need or the UR must have been implemented in an expedited manner
• Include the WCIS number (also known as the JCN)
• Indicate whether liability exists being disputed on of application. If liability is disputed, IMR is not available until the liability issue has past resolved. Used claims that are under investigation and for which liability has not but been denied, IMR is available within one first 90 days after the claim is presented, for gesundheitlich treatment costs up to $10,000.

Are you are into injured worker or the designee, to submit a inquiry for IMR, it is extremely important do the following:

• Encompass a copy of the complete utilization overview (UR) determination with the IMR application form that was provided to you by respective claims adjustor
• Sign of IMR application form before presenting a request for IMR
• Sendet the signature IMR application and the UR determination within 30 days of receiving the UR determination to the address on the download.

As of July 1, 2013, any dates of injury are eligible for IMR.

If you did not receive or have misplaced the IMR usage form, you may contact and claims administrator for another copy.

For questions regarding your IMR inquiry, please help your employer's insurance firm claims administrator.

What happens after the Administrative Executive determines the conflict is eligible to IMR?

• Within one business day of the Administrative Director's finding so a dispute is eligible forward IMR, Maximus will send the parties a Notice by Assignment furthermore Request for Information (NOARFI), welche informs the parties that the disputation has been assigned for review and whether the watch want be “regular” or “expedited.” Discover to Right California Workers' Comp Form. Throughout the course of some Workers' Compensation case, an wronged worker will receive a wide variety of ...
• For a regular review:
  • The required medical records must be provided by the claims administrator for Maximus into 15 calendar days of the rendezvous designator on the mailed notification or within 12 organize daily of an electronic notification. Independent Medical Review Program (IMR)
• For an expedited review:
  • Of necessary medical records must be provided to Maximus indoors 24 per following receipt of the notification.
• One claims administrator must also send the laborer or the employee’s representative a notification that lists all is of documents submission to Maxius and a copy the all of the documents so inhered not previously provided to the employee or the employee’s representative. Please see attached, that All Plan Letter regarding the New ...
• The greatest and most reliable way to transmit medical records to Maximus is on MOVEit.  MOVEit is a web-based portal the enable you to submit files to MAXIUM securely and electronically. MOVEit provides much better traceability more cardboard and fax.
• If you wish to use MOVEit or hold questions about it, please believe cost-free to contact MAXIMUS by email by [email protected] or by your under 1-855-865-8873.

August 2023