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CWCI: IMR Decisions Up 6.3% in 2016

Monday, March 20, 2017 | 1078 | 3

The total number of independent medical review determination letters issued in 2016 increased 6.3% to 176,002 from 165,525 in 2015, and a greater percentage of those decisions upheld the underlying utilization review decision, the California Workers’ Compensation Institute said in a report released Friday. IMR physicians upheld utilization review decisions to modify or deny treatments 91.2% of the time last year, compared to an uphold rate of 88.4% for decisions in 2015. Since 2014, the first full year in which all dates of service were eligible for IMR, the dispute resolution process c...

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Tom Martin Mar 20, 2017 06:05 AM

Alarming when you consider the fact that over 80% of all medical treatment is delivered by employers own MPN physicians! Perhaps they need more training to avoid running into the UR/IMR roadblocks that are preventing rapid healing and return to work! Why aren't the MPNs doing something to reduce this massive frictional cost?

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Albert Navarra Mar 20, 2017 10:29 AM

Hi Tom. I'm not sure I understand your points. If IMR is upholding UR 90% of the time, then what are MPN doctors doing wrong? Also, if IMR is considered a roadblock or frictional cost, it is requested by applicant attorneys, so I'm not sure why employers are to blame.

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Keith More, Esq. Mar 22, 2017 06:48 AM

This is staggering to think how bad these MPN doctors are that are licensed to treat patients in the state of California. They make these awful requests for treatment such as physical therapy, medications or durable medical equipment after establishing a Doctor/Patient relationship. How dare they!!! only to be non certified by a doctor out of state, unlicensed in Ca and most likely not even in the same medical field. Geez I hope I never get injured on the job. A special thanks to the WCAB for the wonderful decision in Dubon II. If only the labor code had any meaning or the words meant something. Maybe then all of the medical records would be sent to UR or a doctor would be an ortho reviewing an ortho. What a concept. Do you think that's what was meant by the State Legislators.

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