REPORT: Independent Medical Report November 2018 shows a 90% denial rate for your treatment appeals, San Bernardino California
If you’re wondering why your treatment is always denied, you have horrendous wait times at your doctor’s office and it takes forever to get treatment done, this is the reason why.
ClevelandMetz is working towards making changes in the system for you, if you have any questions about your doctor in your medical provider network MPN, utilization review UR or independent medical review IMR, contact our office for a free consultation.The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted a progress report on the Department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process for the state’s workers’ compensation system that uses medical expertise to obtain consistent, evidence-based decisions. The report describes IMR program activity in 2018, the sixth year since the program was implemented. The Independent Medical Review Organization administering the program, Maximus Federal Services, Inc., received over 250,000 IMR applications, and issued almost 185,000 Final Determination Letters, each containing one or more medical necessity dispute.
Treatment request denials were overturned at a rate of 10.33 percent, with specialist consultations, office visits and mental health services overturned most often. This means to you is that 90% of treatment requests that were denied by utilization review for injured workers in San Bernardino County were only overturned about 10% of the time which translates to a 90% denial rate for your care. Remember that the doctor who denies your care on appeal never sees you, never conducts an examination, and the doctors name is a secret and anonymous. Hard to believe right?
An average of 15,400 IMR decisions were issued each month. This means there is an extraordinary amount of treatment appeals going to Maximus who runs the independent medical review system. Utilization review has been a denial rate of about 90% which causes long delays in cases, often times causing injured workers become worse in their condition while waiting for treatment and loss of employment.