Independent medical review (IMR) is a process used to determine whether the treatment recommended by an injured worker’s treating physician is medically necessary and appropriate. In some states, IMR is also known as utilization review.
What is IMR?
Independent medical review (IMR) is a process used to resolve disputes between injured workers and insurance companies over the appropriate level of medical care. The IMR process is overseen by the state’s workers’ compensation board, and it is designed to be an objective, unbiased way to resolve these disputes.
When do I need IMR?
In most states, IMR is required when an employer or insurer denies a request for authorization of treatment. The injured worker may also request IMR if he or she disagrees with the employer’s or insurer’s decision to stop paying for treatment that has already been authorized.
How to start with IMR?
In order to initiate an IMR, the insurance company must first send a request to the state’s workers’ compensation board, so read golden state workers compensation reviews. Once the request is received, the board will appoint an independent medical reviewer to evaluate the case and make a determination about what level of care is appropriate.
If you are an injured worker who is involved in a dispute with your insurance company over the appropriate level of medical care, you have the right to request an IMR. You can do this by contacting the state’s workers’ compensation board and requesting that an IMR be conducted.
The IMR process
The IMR process is typically completed within 30 days, and it is important to note that the determination made by the independent medical reviewer is final. This means that if you disagree with the determination, you will not be able to appeal it.
If you are involved in a dispute with your insurance company over the appropriate level of medical care, the IMR process may be able to help you resolve the issue and start to receive medical and compensation benefits. It is important to remember, however, that the determination made by the independent medical reviewer is final and cannot be appealed.
Who conducts IMR?
IMR is usually conducted by a panel of doctors who specialize in workers’ compensation. The panel will review the medical records and may also interview the injured worker, the treating physician, and other health care providers.
IMR is conducted by an independent, third-party reviewer who looks at all of the available evidence to make a decision about whether or not a particular treatment is medically necessary. The reviewer will consider things like the worker’s diagnosis, prognosis, and the potential risks and benefits of the proposed treatment.
If the IMR decision is that the proposed treatment is not medically necessary, the worker will not be able to receive that treatment and will have to pay for it out-of-pocket if they choose to proceed with it.
If you are involved in a dispute with your insurance company over the appropriate level of medical care, you may want to consider requesting an IMR. The IMR process is designed to be an objective, unbiased way to resolve these disputes, and the determination made by the independent medical reviewer is final. However, it is important to remember that if you disagree with the determination, you will not be able to appeal it.
You can request an IMR by contacting the state’s workers’ compensation board.
IMR is an important part of the workers’ compensation system. It ensures that injured workers receive the medical care they need, while protecting employers and insurers from paying for unnecessary or inappropriate treatments.