Regulations
| 9792....Determination of the Fee | |
| (a) The fee is determined by the use of the Official Medical Fee Schedule as defined in Section 9791. 1 of these rules. A medical provider or a licensed health care ...more | |
| 9792.10....Utilization Review Standards-Dispute Resolution - For Utilization Review Decisions Communicated Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013 | |
| The 20-day time limit may be extended for good cause or by mutual agreement of the parties. Â (2) Medical care provided during a concurrent review shall be medical ...more | |
| 9792.10.1....Utilization Review Standards -Dispute Resolution - On or After January 1, 2013 | |
| Neither the employee nor the claims administrator shall have any liability for medical treatment furnished without the authorization of the claims administrator if the ...more | |
| 9792.10.2....Application for Independent Medical Review, DWC Form IMR | |
| DWC Form IMR Note: Authority: Sections 133, 4603. 5, 4610. 5 and 5307. 3, Labor Code. New section filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to ...more | |
| 9792.10.3....Independent Medical Review - Initial Review of Application | |
| (a) Following receipt of the Application for Independent Medical Review, DWC Form IMR, pursuant to section 9792. 10. 1(b), the Administrative Director shall determine ...more | |
| 9792.10.4....Independent Medical Review - Assignment and Notification | |
| (a) The independent review organization delegated the responsibility by the Administrative Director to conduct independent medical review pursuant to Labor Code section ...more | |
| 9792.10.5....Independent Medical Review - Medical Records | |
| (a) (1) Within fifteen (15) days following the mailing of the notification from the independent review organization that the disputed medical treatment has been assigned ...more | |
| 9792.10.6....Independent Medical Review - Standards and Timeframes | |
| (a) The independent medical review process may be terminated at any time upon notice by the claims administrator to the independent review organization that the disputed ...more | |
| 9792.10.7....Independent Medical Review - Implementation of Determination and Appeal | |
| (a) Upon receiving the final determination of the Administrative Director that a disputed medical treatment is medically necessary, the claims administrator shall, unless ...more | |
| 9792.10.8....Independent Medical Review - Payment for Review | |
| (a) The costs of independent medical review and the administration of the independent medical review system shall be borne by claims administrators. For each Application ...more | |
