What Is An Independent Medical Review (IMR)?
An Independent Medical Review, popularly referred to as IMR, is a quick way to resolve worker’s compensation disputes of an injured employee’s medical treatment without taking the case to court. This process is usually conducted if a request by a treating physician for a particular course of therapy is turned down or modified on the basis that the treatment is not medically necessary. In this case, the injured worker can seek the help of their work comp attorney and ask for a review of that decision by physician-conducted IMR.
However, it is important to note that the IMR process cannot be conducted to be used by the insurance company for coverage issues. It can be used for causation, general acceptance, medical appropriateness or ability to go back to work. This simply means that IMR is only used in relation to the practice of medicine that has nothing to do with coverage issues.
How to apply for an IMR
A request from an employee seeking medical treatment first goes through the UR (utilization review) in the worker’s compensation system. This process is carried out to approve that the employee’s condition needs medical treatment. In case the request is delayed, modified or denied, the worker can seek a review through the IMR.
Who conducts an IMR?
An expert independent medical professional conducts the independent medical review. This professional needs to be board-certified and actively practicing in the same area of treatment.
Who pays for the IMR?
The law requires employers to provide their injured workers with all the necessary treatment needed to relieve or cure an occupational injury. The cost of conducting an IMR varies depending on the number of medical professionals required for it and the nature of the dispute. However, the cost of an IRM is considerably lower than the cost of resolving a disagreement through litigation.
What are the objectives of the Independent Medical Review?
The IMR is supposed to analyze different types of clients and a wide variety of circumstances objectively. For instance:
- When a patient appeals the decision of their claim adjustor to access medical care and other medication
- When an employer wants to ensure the most appropriate and the most cost-effective approach to treat their injured worker
- When the patient wants to determine when they can go back to work
- When a workers’ compensation payer wants to establish their responsibility towards the harmed employee
How to submit a request for IMR
Whether you are the complainant or the designated work comp attorney, you are required to do the following:
- Attach a copy of a complete UR determination and a copy of an IMR application form provided by the claim adjustor
- Make sure the IMR form is duly signed before submitting
- Ensure you send the dully-signed IMR application within the 30-day waiting period after receiving the UR determination
- Send it to the address on the form
A good IMR should answer all pertinent questions. It should reference all the appropriate medical guidelines in the easiest way possible, not only for the medical professionals but also for a layperson. Your work comp attorney should look at the IMR report to ensure it meets all state requirements.