Independent Medical Review Delays
Now that July 1, 2013 has passed, Independent Medical Review is applicable to all dates of injury to resolve disputes over a utilization review determination. Since July 1, 2013, how many of us have gone through process to conclusion?
Labor Code section 4610.5(l) provides:
“Upon notice from the administrative director that an independent review organization has been assigned, the employer shall provide to the independent medical review organization all of the following documents within 10 days of notice of assignment:…” (Emphasis added)
Perhaps a better question is: How many of us have received any notice that a case has been assigned for review? There are many stories of cases with dates of injury prior to January 1, 2013 in which an applicant requested Independent Medical Review on July 1, 2013 (or shortly thereafter) and nothing more has occurred. Receipt of the notice of assignment triggers the employer’s duty to provide information to the review organization. This notice is still pending in many, if not most, of these cases.
We know from the Department of Industrial Relations’ website that within one business day of the administrative director’s determination that a dispute is eligible for Independent Medical Review Maximus Federal Services, Inc. will send a notice to the parties that the dispute has been assigned for review. So what is the reason for the delay in assignment?
The reason for the delay might be found in the September 11, 2013 “NOTIFICATION OF INTENT TO RE-ADOPT EMERGENCY REGULATIONS” memorandum by the Legal Unit of the Division of Workers Compensation which provided the following:
“The IMR program has been in effect since January 1, 2013 for occupational injuries occurring on and after that date; and since July 1, 2013 for all occupational injuries regardless of the date of injury. In August alone, the IMRO received 15,731 IMR applications by mail and fax.” (Hat tip to Greg Jones at WorkCompCentral for reporting on this astonishing figure)
It is certainly reasonable to expect the trend of simultaneously requesting Independent Medical Review and an Expedited Hearing to continue.