Nearly nine-in-10 workers’ compensation treatment request denials in California were overturned by independent medical review, a new report shows.
The California Department of Industrial Relations and its Division of Workers’ Compensation released the annual report on the department’s IMR program.
The report summarizes IMR activity in 2025, the 13th year since the program was implemented.
The report shows the organization that administers the program, Maximus Federal Services Inc., received 201,037 IMR applications and issued 152,351 final determination letters. Throughout the year, the organization issued decisions an average of six to seven days after receiving all required medical records, according to the report.
Related: Report Shows California Workers’ Comp Medical Review Denials Still Rarely Overturned
IMR overturned 10.2% of the utilization review decisions that denied treatment requests made by physicians treating injured workers, a rate that was less than in the previous year (12.7%), the report shows.
It shows that 91% of all unique IMR filings were deemed eligible for review, slightly higher than the percentage in 2024. Pharmaceutical requests accounted for 31% of all treatment requests submitted, while opioids comprised 22% of all pharmaceutical requests. The second- and third-highest number of requests were for topical analgesics (18.9%) and muscle relaxants (15.8%).
Treatment request denials were overturned at an overall rate of 10.2%, down from 12.7% in 2024. Program services, behavioral and mental health services, and evaluation had the highest overturn rates.
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California
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