Residents of California who have filed for workers compensation may want to learn more about the IMR (Independent Medical Review) system for disputes. It replaced the court system for review, which costs less and is easier in the long run.
According to industrial relations reports in California, you must prove that treatment is necessary. This happens with a “utilization review.” If you have an injury on the job, they want to be sure that that treatment is appropriate and you will receive relief from the injury.
Who pays for the costs of the IMR?
Your employer will pay the costs. When a dispute arises, it is cheaper for them to resolve the issue this way, rather than in court.
Will you receive updates?
Yes, the claims administrator will send you a copy of the review decision. This will be important if there is any delay or modification of the treatment.
You can submit a request for an IMR
Your claims adjuster will give you forms. You must sign them and submit them within 30 days of the determination. It is the responsibility of the claims adjuster to make sure that you have the decision of the workers compensation treatment request in your hands.
It should not be a MPN-IMR form or a modified or self-created form. The correct DWC IMR-1 form is the one used for the application.
Injured worker submits form
You must do the following:
- Send a copy of the complete utilization review (UR) determination, that the claims adjuster gives to you, with the IMR application.
- Sign it.
- Send both within 30 days of receiving the UR determination to the address on the form.
What is the address to send it?
The address is the following:
DWC – IMR
c/o Maximus Federal Services, Inc.
PO Box 138009
Sacramento, CA 95813-8009