Independent Medical Review (IMR) Application
Download FormWhen a request for medical treatment in a California workers' compensation case is denied, delayed, or modified through Utilization Review (UR), the injured worker has the right to challenge that decision through Independent Medical Review (IMR). The IMR Application is the form that begins that appeal.
What Is Independent Medical Review?
Independent Medical Review is California's process for resolving disputes over medical treatment in workers' compensation claims. It was established under Senate Bill 863 and applies to treatment decisions made on or after July 1, 2013. Rather than a judge, an independent physician with no connection to the insurance company reviews the medical records and decides whether the requested treatment is medically necessary under the state's Medical Treatment Utilization Schedule (MTUS).
When to File an IMR Application
You would use this form after receiving a Utilization Review decision that denies, delays, or modifies the treatment your doctor requested. The UR denial letter you receive should include a blank IMR Application. Completing and submitting it is how you formally ask for an independent review of that denial.
The 30-Day Deadline
Timing is critical. The signed IMR Application must be submitted within 30 days of the date on the Utilization Review denial letter. Missing this deadline can forfeit your right to appeal, so it is important to act promptly and keep a copy of everything you send.
Who Can Submit the Application
The injured worker, the treating physician, or the worker's attorney can submit the IMR Application. The California Division of Workers' Compensation has designated Maximus Federal Services to administer the IMR process and assign the independent medical reviewer.
What Happens After You File
Once the application is accepted, the relevant medical records are forwarded to an independent physician reviewer. That reviewer evaluates whether the requested treatment is medically necessary and issues a written determination. The IMR decision is binding on the parties, which makes a complete, well-documented submission especially important.
How GEKLAW Can Help
The rules and deadlines surrounding Utilization Review and Independent Medical Review are strict and easy to miss. An experienced Workers' Compensation attorney can make sure the application is filed on time, that the reviewer has the medical evidence needed to understand your condition, and that your right to necessary treatment is fully protected. If your treatment has been denied, we can help you understand your options.
