CWCI Reports on IMR Stats from 2022
Happy Monday, dear readers! Your humble blogger has a question for you… a riddle if you will. What is a pirate’s favorite part of California workers’ compensation?
- Labor Code 4662 (because of all the hooks and eye patches, etc.);
- Lien litigation (because of legalized piracy); or
- IM… wait for it… Arrrrrrr!
The answer is obviously C, but I would have also accepted U… wait for it… Arrrrr!
Now that you’re done rolling your eyes at me, let’s take a look at how IMR is doing.
The CWCI has a new report on IMR out, and the results are pretty favorable to the defense community. IMR volume peaked in 2018 but has steadily declined to an all time low since the program started as part of SB-863. In 2022, there were 127,215 requests for IMR as compared to 184,735 requests in 2018. The cost of IMR is $345, so imagine the savings to defendants represented by the drop in IMR requests – almost $20 million!
And, of course, that’s just the cost of IMR alone, not to mention all the unnecessary treatment that defendants were not forced to pay for.
The other interesting statistic is the IMR uphold rate – 2022 saw an uphold rate of 91.1%, down from 92% the year before.
What does this mean? Well, as the system stands right now, odds are very high (as in 91.1% likelihood) that a UR determination will stand. That is why it is so important for defendants to conduct timely and technically effective utilization review of RFAs, which includes not only timely responses but also proper and timely communication of the results to the parties involved (AA, requesting doctor, etc.)
What else does it mean? Sacramento sees a fortune of costs being avoided by employers and insurers and is working diligently to prevent those savings, or, at the least, curtail them as much as possible. Efforts are under way in Sacramento to require all UR physicians to not only be licensed in the relevant specialty as required for the RFA, but also to be licensed in California.
There is clearly no purpose to this other than to make UR more expensive for employers by limiting the pool of physicians available to conduct UR. Likewise, as discussed previously on this most humble of blogs, Sacramento is attempting to increase TTD for those 8.9% of IMR results that reverse the UR determination, extending TD beyond the 104 week cap for periods spent awaiting an IMR reversal. At present, there is little enough incentive for AAs to request IMR, let alone litigate any technical deficiencies in the IMR results, knowing that less than 10% of those decisions will be reversed. The prospect of an extra 2 months of TD will provide plenty of such incentive.
SB863 went into effect more than 10 years ago now, and while it failed to eliminate Ogilvie explicitly, and, sadly, failed to eliminate Almaraz/Guzman as well, limiting the jurisdiction of the WCAB to reverse UR and instituting the IMR process is likely proving to be one of the biggest cost-saving measures for California’s employers.
Avast ye mateys! Wednesday ahoy!