Workers’ Comp IMR: Take As Long As You Want

 In Workers Comp

Independent Medical Review is the appeal process in workers’ compensation for Utilization Review denials of medical treatment.  The IMR appeal goes to an anonymous state assigned doctor who issues a binding, non-appealable decision. Labor Code § 4610.6(d) states that the decision shall be made within 30 days within receipt of the supporting documents.  The purpose of the time line is to ensure prompt decisions on medical treatment disputes in workers’ compensation cases.

What happens if the IMR decision is late, even by months, in violation of the 30 day rule?  Does the injured worker get the treatment, or does the dispute get assigned to another doctor?  Nothing happens, according to the Court of Appeals in a recent case.  “Shall” means nothing when it comes to helping injured workers, because the Labor Code does not include an “or else”.  So, the state and IMR can take as long as they want to issue a decision, regardless of the “expeditious remedy” mandate in workers’ comp.

Let’s put this in context.  The Ten Commandments say “Thou shalt not commit adultery”.  Now, there’s no “or else” inscribed on the tablet, but everyone knows there’s an “or else”.  You tell your kids that they shall clean their room within the next hour.  You don’t have to say “Or I’ll knock you into next Tuesday” for there to be consequences.  The court disagreed with this logic, stating that shall is not mandatory, but merely directory.  Wait.   What?

Injured workers are stuck with IMR and UR, it looks like, until workers’ compensation laws are changed by the legislature.  Please contact your state senator and assembly person and demand that they repeal these harmful workers’ compensation laws.