WCDefenseCA

Hi there, dear readers – if you are not mad at me for Monday’s post.  I didn’t realize the suggestion that injured workers who lie at deposition or to a physician shouldn’t be trusted with any of their statements would be so controversial.

Anywho, let’s touch a slightly less controversial topic then – IMR!

As this week of good news continues, I offer you the Lexis summary of a recent CWCI study reflecting that IMR has had a 2.2% decline in requests since 2016 (about 3.8k fewer requests).

However, we’re still looking at 91.2% of IMR determinations upholding UR decisions in 2017.  That’s awesome!

So, let’s take a look at some of the realities.  First off, IMR is going to cost defendant about $400 or so, which means that it might be prudent to weigh the cost of the requested treatment against the cost of the IMR.

On the other hand, if you are an applicant attorney and you are requesting IMR, you have to know that there is a 91.2% chance of UR being upheld.  What does that mean? That means that you are not requesting IMR with the realistic expectation of getting UR overturned.  You are requesting IMR to inflict costs on the defendant.

Some applicant attorneys have boasted loudly at the Board that their intent has always been to IMR every UR denial in an effort to overwhelm the system and/or to drive up costs for defendants.

One of the things your humble blogger has observed time and time again is the frustration from some applicant attorneys, WCJs, and even other defense attorneys that defendants are paying so much money for UR and IMR on treatment that, if approved right away, would not cost as much.  What’s more, defendants sometimes even pay their attorneys to appear on these issues.

Well, there’s a good reason for this – if you roll over and provide unnecessary treatment every time it’s cheaper than UR and IMR, the requesting physicians will get wise to this and start requesting small bits of treatment over and over again.

What’s more, just like applicant attorneys have an interest making IMR cost as much as possible to encourage a more generous C&R, defendants have an interest in sending a clear message that lifetime medical treatment may well be awarded, but it will be strictly controlled by UR/IMR (and possibly even the MPN now and again).  The fact that UR is upheld nine times out of ten significantly reduces the value of future medical care, which makes a reasonable C&R that much more feasible.

What about the 2.2% decline in IMR requests?  I wouldn’t put too much weight in it just yet.  Sure, your humble blogger can fantasize about the unhappy applicant attorney deciding he’s not going to waste time with IMR requests anymore because UR always get upheld, but the more likely scenario is that there are going to be random fluctuations here and there, and unless we see a consistent reduction in IMR requests over the next few years.

So, rejoice, dear readers!  IMR seems to continue to serve the defense community well in limiting the obligation to provide medical treatment to truly reasonable and necessary requests.  Now, if we could just get the UR vendors to work on the Friday after Thanksgiving…