CWCI Finds California Workers’ Comp Independent Medical Reviews Are Trending Up

After declining steadily from 2018 through 2022, the number of Independent Medical Review (IMR) decision letters issued in response to California workers’ comp medical disputes is now trending up, increasing in 2023, 2024, and the first quarter of 2025 according to the California Workers’ Compensation Institute (CWCI), but the uphold rate for medical service modifications and denials that are reviewed remains close to 90%.

CWCI’s latest review of IMR activity and outcomes examined 1.57 million IMR decision letters issued from 2015 through March of this year in response to applications submitted to the state after a Utilization Review (UR) physician modified or denied a workers’ comp medical service request. As in prior reviews, CWCI tracked the number of letters issued each quarter; determined the distribution and uphold rates for disputed treatment requests by type of medical service (and the distribution and outcomes of pharmaceutical IMRs by major drug group); measured IMR response times; and calculated the percentage of IMRs associated with high-volume physicians.

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