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When you’re injured on the job, navigating the complexities of workers’ compensation claims can be as challenging as the recovery process itself. Understanding the role of an Independent Medical Review (IMR) is critical in these situations.

This blog delves into the nuances of IMR and its impact on your workers’ compensation case, along with insights on how an employment law attorney can be instrumental in advocating for your rights. Contact PLBH now at (800) 435-7542 to request a free legal consultation.

What is an IMR?

An Independent Medical Review is a crucial step in the workers’ compensation claims process. It serves as a tool for employees to challenge an insurance company’s decision to deny, delay, or modify medical treatment coverage. Essentially, it’s an avenue to seek a second opinion on the medical necessity of the treatment plan proposed by your physician.

The IMR Process Explained

The IMR process kicks into gear when there is a disagreement between the injured employee and the insurance provider regarding the recommended medical care. After the initial treatment request is submitted and reviewed, and if the insurance company’s utilization review concludes that the proposed treatment isn’t medically necessary, you have the right to request an IMR. The insurance company bears the cost of this review, which must be initiated by submitting an application form alongside the utilization review decision letter within a strict 30-day window.

The Role of Medical Experts in IMR

A panel of independent medical professionals, who have no prior involvement with the injured worker, is tasked with evaluating the IMR. Their objective is to determine whether the treatment denial was justified based on medical grounds. However, they operate with limited access to the worker’s medical history, which can sometimes result in decisions that do not fully account for the individual’s medical needs.

Responding to an IMR Decision

It’s not uncommon for an IMR to uphold the insurance company’s denial of treatment, given that the insurance provider selects and finances the IMR process. This can present a significant challenge for the injured worker seeking to overturn a decision that their treatment isn’t necessary.

When to Consult an Employment Law Attorney

Receiving an IMR document can be a critical moment in your workers’ compensation case. It’s advisable to contact an employment law attorney to review your case and explore potential errors or misjudgments in the utilization review decision. An experienced attorney can guide you through the IMR process and discuss the potential outcomes for your specific case.

The Importance of Timely Legal Advice

Timing is of the essence when dealing with IMRs due to their stringent deadlines. Consulting with a workers’ compensation attorney as soon as you receive a treatment denial can make a decisive difference. A skilled lawyer will have an in-depth understanding of the IMR process and can help you navigate the complex waters of workers’ compensation claims.

Remember, an IMR can be a turning point in your case, and having a knowledgeable attorney by your side can ensure that your rights are protected. If you’re facing an IMR situation, reach out to PLBH at (800) 435-7542 or via email for a comprehensive evaluation of your case and personalized legal support.