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California sees drop in medical reviews for injured workers

By Louise Esola

California saw an 11.3% drop in workers compensation independent medical review letters in 2019 when compared with 2018, according to a report issued by the California Workers’ Compensation Institute on Sunday.

Pharmacy-related reviews accounted for 78% of the decrease, the report said.

The overall drop marked only the second year-to-year decline in IMR letter volume since the Oakland, California-based CWCI began monitoring IMR outcomes in 2014 and is considered by the organization as the most “significant” decrease, according to the report.

Medical reviews are in line with state law aimed at ensuring treatments for injured workers are adequate and evidence-based and there is a protocol in place for treatment denials. In 2019, IMR physicians upheld 88.2% of all treatment modifications and denials, close to the 88.6% uphold rate in 2018, according to the report.

Researchers are seeing a downward trend in medical reviews that has continued this year, as there were 4.9% fewer letters issued in the first quarter than in the first quarter of 2019, according to the report.

Pharmaceutical requests again topped the list of medical services submitted for IMR in 2019, representing 41.1% of IMR decisions, down from 46.4% in 2018. First-quarter 2020 results show further declines, with pharmaceutical requests accounting for 39.9% of IMR determinations issued.

Opioid requests again comprised the largest share of the pharmaceutical IMRs in 2019 at 30.9%, down from 32.2% in 2018, according to the report.

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