Sample Determination of Independent Medical Review (IMR)
Download FormThe document above is a sample of a determination issued through Independent Medical Review (IMR) — the written decision that resolves a dispute over medical treatment in a California Workers' Compensation case.
IMR Determination Timelines
For a "regular" IMR review, the final determination is due within 30 days of Maximus receiving the IMR Application and supporting documentation. For an "expedited" review, the determination will be made within 3 days of receipt of the application and supporting documentation.
What the Decision Means
The decision issued by Maximus is binding on all parties, except on very limited grounds for appeal. If the disputed treatment is deemed medically necessary, the insurance company must authorize the treatment within 5 business days. If the denial is upheld, that decision generally stands for one year, unless there has been a material change in facts.
Appealing a Determination
If one of the limited grounds for an appeal exists, the final determination can be appealed within 30 days. Because those grounds are narrow, it is important to make the strongest possible case during the review itself.
How GEKLAW Can Help
The IMR process moves quickly and the decision carries real weight. An experienced Workers' Compensation attorney can help make sure the reviewer has the complete medical record needed to evaluate your treatment, and can advise you on whether an appeal is available. If your treatment has been denied, we can help.
