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CA Workers’ Comp IMRs Mostly Involve Prescription Drug Disputes

Pharmacist showing woman a prescription bottle

According to a recent study from the California Workers’ Compensation Institute (CWCI), most Independent Medical Reviews (IMR) in the state are related to prescription drug disputes. An IMR, in the words of the California Department of Industrial Relations (DIR), is a review process used to “resolve disputes about the medical treatment of injured employees.” Usually, an IMR becomes necessary if a physician modifies or denies the proposed medical treatments for an injured employee covered by workers’ compensation benefits. In rare cases, an IMR can be ordered if the patient believes they should be getting a different or better medical treatment, and the IMR will determine if the employee’s requests are reasonable and could actually result in a medical improvement for them.

The CWCI found that nearly 40% of all IMRs in 2020 were related to prescription and pharmaceutical drug disputes. This percentage actually fell considerably, having reached a high point above 46% in 2018. It is believed that historic job loss during the coronavirus pandemic caused fewer workers’ comp filings overall, which could explain the drop-off.

Other topics of discussion in IMRs that went up or down noticeably in the last few years are:

  • Dermatological treatments
  • Physical therapy
  • Injectable medications
  • Prosthetics
  • Splints and other orthotics
  • Durable medical equipment like wheelchairs

A majority of IMRs related to prescription drugs suggest that many physicians working with injured employees on workers’ compensation programs are hesitant to prescribe strong painkillers. Opioid prescriptions used in California workers’ compensation cases have dropped 4% in the last two years due to concerns about the opioid addiction epidemic, so physicians have had to prescribe alternatives.

It is worth noting that nearly 90% of all IMRs end in favor of the physician who initially decided to modify or deny an injured workers’ medical treatments. In other words, if a physician decides that you should get a prescription for medical-grade acetaminophen instead of an opiate, then there is a nine-in-ten chance that their decision will be upheld after an IMR. This rate increased slightly from 2019, which could be the start of a new trend.

Do you disagree with your medical treatments after being hurt at work? Is the physician or insurance company working on your case trying to change the parameters of your treatments? You should call Alvandi Law Group, P.C. at (800) 980-6905 and discuss your options with our workers’ compensation attorneys. We can help you better understand your rights and options as an injured employee with a case headed towards an Independent Medical Review. From our office in Orange County, we provide legal services to clients throughout the region, so don’t hesitate to contact us today.

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