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IMR Rules Reward Carriers Who Don't Send Records , Critics Say
12/11/2013
whether an injured worker needs a certain treatment without reviewing any medical records.
In addition the proposal would allow the DWC administrative director to determine that an IMR decision is not valid because the case should not have been deemed eligible for review in the first place. The rules
Category: News
Revised IMR Rules Allow Decisions without Records
12/10/2013
The Division of Workers' Compensation posted for comment revised utilization-review and independent medical-review regulations that would among other things allow a medical reviewer to issue an IMR decision even if the claims administrator fails to submit medical records.
Other changes would
Category: News
DWC Plans Meeting to Seek a Consensus on IMR and UR Fix
12/04/2013
approved automatically without having to go to utilization review.
Id like claims adjusters to have the authority to simply authorize rather than submit everything to UR which is why we have so many IMR requests each month he said.
Butler said independent medical review is a good idea that was
Category: News
DWC Rescinded Maximus IMR Decisions for Lack of Records
11/22/2013
for lack of records when more than two IMR decisions have been made without medical records.
A review of IMR decisions by WorkCompCentral in July found five determinations that were made without the claims administrator submitting requested medical records. One of those cases 13-740 was rescinded
Category: News
Employers Call Proposed IMR Provisions Unworkable
10/16/2013
approved for review and IMR decisions being made without the claims adjuster providing relevant medical information to the review organization.
The revised rules say that the administrative director must determine if a dispute is eligible for IMR within 15 days of receiving the application and all
Category: News
Incomplete Applications Slowing IMR Process, Regulators Say
10/04/2013
the division to make an eligibility determination and it might take us some time. We allow 30 days to make that eligibility determination.
After a case is determined eligible for IMR the claims administrator is notified and has 15 days to submit relevant medical records going back at least one
Category: News
DWC Adds Timeline, Penalties to IMR Rules
09/30/2013
fine for not providing medical records and other necessary documents to Maximus to 500 a day from 100 a day. The maximum penalty of 5000 is unchanged.
At least five IMR decisions published on the DWC website indicate that the IMR doctor upheld a utilization-review determination that the requested
Category: News
Maximus Mum on Delays after Spike in IMR Requests
09/26/2013
relevant medical records and other documentation within 15 days of the date designated on a mailed notification or within 12 days of receiving electronic notification.
Maximus has 30 days from receiving the IMR request form and the supporting documentation to issue a decision on a regular review and
Category: News
UR Decisions Upheld without Review of Medical Records
07/29/2013
By Greg Jones Western Bureau Chief
Independent medical review doctors denied recommended treatments for five injured workers in California without reviewing all pertinent medical records despite statements from the Division of Workers' Compensation's IMR contractor that it needs the records to
Category: News
Attorneys Say IMR and Add-On Language Will Lead to Disputes
07/19/2013
another possibly expensive mistake that adjusters could make Failing to send a completed independent medical review application along with the UR decision denying treatment. DWC rules require adjusters to send the completed IMR application with the UR letter so on its face the UR decision wouldnt be
Category: News
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