So, dear readers, how are we feeling about the Independent Medical Review process?  It’s a coming pretty soon, and it won’t be long before the independent medical review board is handling all cases.

Under Labor Code section 4610.5, IMR is now the name of the game – no more medical disputes to be put to PQMEs, and just Utilization Review and the IMR to decide whether applicants get those medically-necessary hot-tubs and large-screen TVs to relieve from the effects of the latest paper-cuts and stubbed toes.

Now here’s an interesting question to answer: how enforceable is Labor Code section 4062.2, subsection (f)?  After all, that section says that “[t]he parties may agree to an agreed medical evaluator at any time, except as to issues subject to the independent medical review process established pursuant to section 4610.5.”

So applicant and defendant are sitting there looking at a UR report which recommends that authorization for a recommended medical treatment be denied.  In theory, this can go to the IMR, but what if defendant or applicant proposes an alternative – “Hey, Jerry, why don’t we write a letter to the AME and have him address this instead?”

Well, why don’t they?

Sure, section 4062.2(f) says they can’t… but who is going to stop them?  If the applicant agrees, and defendant agrees, whatever the result will be, the time for conducting the IMR process will have passed by the time the AME report comes back.  And, after all, if either party goes back on its word… well… workers’ compensation is a fairly small community, and one doesn’t get many opportunities to break a promise to the same person.

After the panel process was forced on the workers’ compensation community as part of SB-899, many parties (even for injuries after 1/1/05) retained their own QMEs, and many workers’ compensation Judges turned a blind eye… perhaps we can expect the same thing for years to come?