After hitting an all-time low in 2022, the number letters from doctors regarding injured workers challenging the denial of treatment or medications in the workers compensation system in California increased 4.1% in the first half of 2023 compared with the same period last year, according to a report issued Monday by the California Workers’ Compensation Institute.
The number of letters and individual decisions remained below pre-pandemic levels, according to the report.
Total IMR volume trended down for four consecutive years, from 2019 through 2022, as the number of work injury claims fell during the pandemic and pharmaceutical disputes declined after the state adopted the evidence-based Medical Treatment Utilization Schedule Prescription Drug Formulary and Pain Management and Opioid Guidelines.
After climbing to a record 184,735 letters in 2018, IMR letter volume declined 31.1% over the next four years, falling to 127,215 letters in 2022. While IMR decisions were down across all medical service categories, the addition of the treatment guidelines in late 2017 and the implementation of the formulary in January 2018 had “a huge effect” as prescription drug disputes fell from 47.3% of all IMRs in 2017 to 33.3% in 2022.
As in previous reviews, the latest data show that a small number of physicians continue to drive much of the IMR activity, with the top 1% of requesting physicians — 80 doctors — accounting for 40.3% of the disputed service requests that underwent IMR in the 12 months ending on June 30.