Medical Care, QME, UR & IMR
Getting the right medical treatment is often the hardest part of a workers’ compensation case. Since Senate Bill 863 took effect in 2013, a treating doctor’s requests go through utilization review (UR), and disputes over denied treatment are decided by independent medical review (IMR) rather than by a judge. Disagreements about the extent of an injury are sent to a Qualified Medical Evaluator (QME), or to an Agreed Medical Evaluator chosen by both sides when the worker has an attorney.
These articles explain how each step works, how to pre-designate your own physician before you are hurt, what to do when care is delayed, and how the courts have shaped the process. They also cover conditions that are often under-treated, including chronic pain, complex regional pain syndrome and traumatic brain injury.
Our guides on this topic
All 24 articles
- Quality QME Guide: Avoid the #1 Mistake Injured Workers MakeLearn why choosing a quality Qualified Medical Evaluator (QME) is the most important step an injured worker can take to protect their claim.
- CA Supreme Court Issues Decision That Brings Into Focus Utilization Review and the "No-Fault" Nature of the Workers' Compensation SystemThe California Supreme Court ruled that utilization review doctors are not personally liable for an injured worker's seizures after termination of medication, reaffirming the no-fault nature of California's workers' compensation system.
- Have you Suffered a Traumatic Brain Injury Without Even Knowing It?In 2018, GEKLAW explains overlooked signs of work-related traumatic brain injury, why concussions get missed, and how proper medical evaluation helps.
- Differing Court Decisions Highlight the Importance of Timelines in Medical Treatment DisputesAdam Dombchik explains two conflicting California Workers' Compensation decisions on whether Independent Medical Review deadlines are mandatory—and why it matters for injured workers.
- Controlling Your Medical Treatment: Is Pre-designation the Right Option for You?Pros and cons of pre-designating a doctor for work injuries in California workers' comp, plus eligibility rules, forms, and what to expect.
- Court of Appeal To Hear Oral Arguments Regarding the Constitutionality of the Independent Medical Review ProcessAttorney Richard Felton discusses the California Court of Appeal case challenging the constitutionality of the Independent Medical Review process.
- Chronic Regional Pain Syndrome (CRPS) and Workers' Compensation—What You Need to Know About Your BenefitsComplex Regional Pain Syndrome (CRPS) can follow a workplace injury. Learn symptoms, diagnosis, treatment, and how to pursue workers' compensation benefits.
- Legal Challenges Are Made To The Medical Treatment Dispute Resolution ProcessTwo landmark California cases challenge the medical treatment dispute resolution process—utilization review (UR) and Independent Medical Review (IMR)—affecting injured workers' care.
- Complaint Form Issued for Employers, Insurers that Delay Medical TreatmentThe Division of Workers' Compensation introduced a Utilization Review complaint form to address delays and denials of medical treatment in California Workers' Compensation claims.
- Comp Claimants With Attorneys Can Choose New Medical PanelsA Workers' Compensation Appeals Board ruled that an unrepresented worker who retains counsel can pick another Qualified Medical Evaluator. The safest course of action for an injured worker is to hire a qualified Workers' Compensation specialist.
- Workers' Compensation Appeals Board Affirms Worker's Right to Invalidate Flawed Utilization Review DecisionsThe Dubon v. World Restoration decision confirms that judges can invalidate flawed Utilization Review denials, protecting California workers' access to care.
- Final Regulations Set for the IMR ProcessCalifornia's Office of Administrative Law approved final IMR regulations in February 2014. Learn how these rules affect workers' compensation medical reviews.
- Understanding Independent Medical Review: Fighting for Medical CareAn article about how Senate Bill 863 changed California's Workers' Compensation system through the Independent Medical Review (IMR) process.
- The Problem with IMR is URWhy IMR volumes exploded after SB 863: UR denials and systemic issues with treatment authorization in California workers' compensation.
- Taking a Creative Look at SB 863 and Independent Medical ReviewGEKLAW attorneys presented a creative, in-depth analysis of SB 863 and California's Independent Medical Review process at the 2013 CAAA Summer Convention, helping professionals navigate the law's new medical treatment rules.
- Know Your Rights to Medical Treatment for Work-Related Injuries (Regardless of Date of Injury)GEKLAW explains your rights to medical treatment after a work-related injury, including predesignated physicians, MPN rules, and SB 863 utilization review deadlines.
- Finding a Doctor to Treat a Job-Related InjuryLearn how to find or pre-designate a doctor for your workers' compensation claim, including Medical Provider Networks and Requests for Authorization rules.
- Labor Code Inclusion Is a Positive Aspect of Senate Bill 863Senate Bill 863 confirms the alternative impairment rating method from the Guzman case, ensuring doctors may depart from strict AMA Guides interpretation when necessary to provide accurate permanent disability evaluations.
- New Workers' Compensation Law Leads to Independent Medical Review ProcessCalifornia's SB 863 reforms introduce the Independent Medical Review process for resolving medical treatment disputes in the workers' compensation system.
- Senate Bill 863 – Governor Brown and the Legislature Reform Workers' Compensation… AgainGovernor Jerry Brown signed Senate Bill 863 into law in 2012, reforming California's Workers' Compensation system with changes to disability benefits, medical review, and injured worker rights.
- We Must Stand Up Now Against SB 863GEKLAW explains why attorneys, doctors, injured workers, and labor organizations oppose Senate Bill 863 and warn of its harmful impact on workers' compensation rights.
- Fishing Through Your Medical Records: The Dreaded Blank Medical Release FormWhen it comes to medical release forms, don't sign one that leaves the doctor-facility entry blank.
- Examining the Role of a Nurse Case Manager in a Workers' Compensation CaseThere are pros and cons to utilizing a nurse case manager in a Workers' Compensation case. Learn when they help, when they don't, and what injured workers should know.
- Court Clarifies Procedure for Spinal Surgery Disputes in Workers’ Compensation CasesCalifornia workers' compensation decision clarifies how insurance carriers must handle disputes over spinal surgery requests from treating physicians.
