IMR stands for “independent medical review” in workers’ compensation proceedings. It is a method by which an employee can ask for a review of the insurance provider’s choice to decline coverage for medical care. Keep reading to learn more about it and contact PLBH at (800) 435-7542 if you require a consultation with an experienced employment law attorney.
The IMR process in action
When an employee gets hurt at work, the employer’s workers’ compensation insurance usually pays for the employee’s medical care. Before a treatment plan may be authorized, the treating physician must submit a “utilization review” request and provide documentation of the patient’s medical necessity.
The injured employer may next request an independent medical review (IMR) of this decision if the utilization review concludes that the treatment is not medically necessary, denies the request, delays it, or modifies it. The employer is responsible for covering the IMR’s expenditures.
The claims administrator must send an IMR application form and a copy of the utilization review decision letter whenever a workers compensation treatment is declined, postponed, or amended. Within 30 days of the ruling, the injured employee (or his or her workers’ compensation attorney) must submit the application and supporting paperwork. A team of medical experts from an outside service provider will next analyze the IMR to determine if the denial was appropriate.
A panel of medical experts who haven’t previously examined or treated the wounded worker make decisions about whether to sustain or reject the insurance company’s denial, delay, or modification of the sought medical treatment throughout the IMR process. This team may treat the scenario as an isolated incident because it has limited access to the employee’s medical records (rather than a broader medical issue).
What should you do if IMR paperwork is received?
IMR reviews typically justify a benefit denial. This can be as a result of the insurance provider selecting and funding the review. It is very difficult, if not impossible, to disprove the assumption that the sought therapy is not medically necessary for the damage sustained once the insurance company has received two distinct rulings rejecting the requested treatment.
Therefore, if you have received IMR papers, get in touch with our office as once to go over your alternatives. Our skilled workers compensation attorneys may examine your utilization review denial and identify any errors in the documentation or judgment.
Additionally, if you decide to proceed, we may go over the advantages and disadvantages of filing an IMR in your particular situation and help you with the process. It is advisable to speak with a workers compensation attorney as soon as you can after obtaining a denial for initial treatment because IMRs have incredibly severe deadlines. Our attorneys have in-depth understanding of filing IMRs and other aspects of workers’ compensation. To arrange a consultation, get in touch with our office right away at (800) 435-7542 or info@plblaw.com.