(c) 2016 Jon L Gelman, All Rights Reserved.

Tuesday, April 8, 2014

IMR Removed Compromise

The Independent Medical Review process in California was developed to take medical decision making out of the workers' compensation courts so that the judges can spend more time deciding things that they presumably have more expertise on: evidence, disability rates, causation, etc.

And as in most things in workers' compensation, on the face of it the IMR process seemed reasonable. Certainly to me it seemed reasonable.

The Workers’ Compensation Insurance Rating Bureau in October 2012 projected the IMR process would save $390 million a year by keeping about 5,000 disputes from going before workers’ compensation judges each month.

At first the estimates seemed accurate. There were only 870 applications for IMR submitted in the first six months of 2013.

But then trouble transpired.

The number of requests increased to 4,410 in July when all dates of injury were eligible and then spiked to 15,731 in August. Since then Maximus has received more than 10,000 IMR requests each month.

Employers and carriers blame the applicant attorneys for requesting IMR for everything.

Applicant attorneys blame employers and carriers for unreasonably denying everything.

Physicians seem caught in the middle and just throw up their hands in frustration.

The truth is probably that everyone is correct.

What the WCIRB failed to estimate is how many medical disputes never made it to workers' compensation judges in the first place because issues were negotiated, compromised and settled. The WCIRB...

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