Sample Determination of Independent Medical Review (IMR)

The final determination for a "regular" IMR review is 30 days of receipt of the IMR Application and supporting documentation. For an "expedited" IMR review, the determination will be made within 3 days of receipt of the IMR application and the supporting documentation.

The decision issued by Maximus is binding on all parties, except for some very limited grounds for appeal. If the disputed treatment is deemed medical necessary by Maximus, the insurance company must authorize the treatment within 5 business days. If the disputed treatment is upheld by Maximus then this decision stands for a year, unless there has been a material change in facts.

If one of the limited grounds for an appeal exists, then the final determination can be appealed within 30 days of the mailing of the determination.

IMR Timeframes are detailed in Labor Code 4610.5and Regulation 9792.10.6 and 9792.10.7