Navigating the Appeals Process for an IMR Decision in Workers’ Compensation

In California workers’ compensation, an Independent Medical Review (IMR) can be a crucial step in determining the course of your medical treatment and benefits. However, what happens when you receive an IMR decision that you disagree with? This blog post will guide you through the process of appealing an IMR decision, ensuring that your rights and medical needs are properly addressed.

Understanding the IMR Process:

By way of background, it’s important to understand the IMR process itself. IMR is a mechanism designed to resolve disputes about the medical necessity of treatment in workers’ compensation cases. When a Utilization Review (UR) denies or modifies the treatment requested by the treating physician, there is a disagreement between you, your treating, an IMR can be initiated by the injured worker within the time limits and format permitted by law.

Reasons for Appealing an IMR Decision:

You may consider appealing an IMR decision if you believe that:

1. The IMR Decision is Incorrect: If you disagree with the IMR decision and believe that it doesn’t accurately reflect your medical needs based on the records in your case.
2. New Information Emerges: New medical information or circumstances arise that were not considered during the initial IMR process and could impact the decision.

Steps to Appeal an IMR Decision:

1. Review the Decision: Carefully review the IMR decision to understand the rationale behind it. Note any discrepancies or areas where you believe the decision is incorrect.
2. Request Reconsideration: In California, you have the option to request appeal the decision by filing a timely challenge before the Workers Compensation Appeals Board (WCAB). This involves filing a written appeal along with any supporting evidence that you believe should be considered based upon the grounds the law provides.
3. Seek Legal Assistance: If medical treatment is denied by UR and IMR, consider seeking legal assistance from an experienced workers’ compensation attorney. They can help you explore additional legal avenues, including challenging the UR and the legality of denying the medical treatment you deserve.

 Conclusion:

Appealing an IMR decision is a vital step if you believe your medical treatment and benefits are not being appropriately provided. Understanding the process and seeking legal assistance when necessary can make a significant difference in the outcome of your workers’ compensation treatment.

If you’re facing an IMR decision that you wish to appeal, don’t hesitate to contact Thomas F. Martin, PLC, a trusted workers’ compensation attorney in Orange County with over 30 years of experience, at 714-547-5025. Pursuing your rights in the workers compensation system is his priority, and he is dedicated to ensuring you receive the care and benefits you deserve.