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COA Upholds IMR Again!

Happy Friday, dear readers!

Your humble blogger is always happy to bring you good news, especially on a Friday.

Due to the hard work and diligence of the appellate counsel for State Compensation Insurance Fund, the Court of Appeal for the third appellate district has issued a ruling confirming what we all knew, what applicant attorneys dreaded, and what the other Courts of Appeal have already found: IMR is constitutional!

In the case of Ramirez v. WCAB, applicant/appellant “challenges the constitutionality of the independent medical review process.  He claims it violates the state Constitution’s separation of powers clause, and state and federal principles of procedural due process.”  In response the Court of Appeal, in a published decision, concluded “the Legislature’s plenary power over the workers’ compensation system precludes any separation of powers violation, and the process afforded workers under the system afford sufficient opportunity to present evidence and be heard.”

Don’t look so surprised, dear readers – this is just part of a trend, and as we all know, a trend is your friend!

Stevens held that IMR is constitutional, even when late, and Margaris seemed to confirm this as well.

I won’t go into the specific reasoning by the Court of Appeal because the ruling is published and controlling – IMR will continue to be the sole arena for determining appropriateness of medical treatment for timely denied or modified UR, and this determination will be taken out of the hands of QMEs, AMEs, lawyers, and judges.

For better or for worse, IMR will continue to be an instrument to reduce employer liability for medical treatment and for litigation costs associated with the issue.  Furthermore, because IMR can be late, there appears to be little incentive to expand the capacity or volume of IMR, because it is of benefit to the employers to delay an IMR determination as much as possible: after all, wouldn’t you rather pay for something later than earlier?

Well, here’s the downside – if the medical treatment is necessary to bring the injured worker to a P&S state, then the employer might be stuck paying TTD until IMR issues a decision.  Fortunately, there’s an easy solution to this, which involves taking a glance and the proposed treatment and authorizing it if it is likely to bring about a P&S status.  After all, if you’re going to authorize the treatment anyway, who is harmed when you fail to do the UR (except the bank account of the UR vendor)?

But, when it comes time to negotiate a C&R, the prospect of having superfluous and unnecessary treatment being reduced by IMR should make the demands more reasonable, which is good for the defense.

So, good news, dear readers – enjoy your weekend!

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