California’s workers’ compensation is a robust system intended to ensure that workers who are injured on the job receive the medical care they require. It includes processes designed to make that care prompt and adequate to return the worker to health. However, in spite of these protections, disagreements will happen.
It starts with your treating physician
When you are injured at work, your first step will be to see a doctor, who will evaluate your injury. The doctor will then make a diagnosis and recommend a course of treatment specific to you and your injury. That recommendation is forwarded to your employer or the claims administrator who handles the employer’s workers’ compensation claims.
The utilization review
Once your employer (or their administrator) receives the treatment plan, they must review it – this is known as a utilization review. Upon completion, the employer must decide whether to approve the physician’s intended treatment plan or to deny it. The employer can also choose to delay or modify the plan.
The independent medical review
An employee may not agree with the employer’s decision following the utilization review. If this is the case, the employee can use an independent medical review (IMR) to resolve the dispute. The IMR is conducted by independent medical professionals and the cost is paid for by the employer. When the employer sends you its utilization review decision, it is required to send you the form you need to request an IMR. You then have 30 days to submit your IMR request.