SAN FRANCISCO – The California Supreme Court recently decided not to consider a challenge to the state's independent medical reviews (IMRs) for injured workers as part of workers' compensation appeals and in doing so supported a prior ruling by the California 1st District Court of Appeal, which said that such medical reviews are constitutional.
Francis Stevens, who uses a wheelchair, sued the state's Workers' Compensation Appeals Board saying the IMR process was unconstitutional after it denied her request for an in-home health aide to assist with tasks of daily living and picking up medications.
Before 2013, if there were disputes between employees and employers over medical care in California, they were resolved in court. SB 863, Gov. Jerry Brown's landmark workers' compensation reform bill, changed all that by requiring disputes to be handled by IMRs.
“The reason IMR was created was because it was taking nine to 12 months to resolve a dispute over the treatment needed for an injury," Peter Melton of the California Department of Industrial Relations told the Northern California Record. "Under IMR, it takes a little over one month."
Employees' claims first go through the state's utilization review process, where it's decided whether to approve or deny specific medical treatments.
"If utilization review denies, delays or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, the injured employee can ask for a review of that decision through IMR," Melton said.
Employers pay for IMRs, which are conducted by independent doctors working for Maximus Federal Services Inc. in Reston, Virginia.
"By relying solely on the judgment of medical experts rather than judges, IMR reduces litigation costs and frictional systems costs," Melton explained.
The verdict on whether IMRs are truly saving employers money is still out, however.
The California Workers' Compensation Institute earlier this year said in a report that "the data is still too green to reach any final conclusions regarding the impact of the IMR process."