Riverside Independent Medical Review Lawyers for Your Workplace Injury Claim
If you’ve been injured on the job in California, you are entitled to workers’ compensation. Actually obtaining workers’ comp benefits, however, is often much more complex and challenging than it should be. If your employer or their workers’ comp insurance provider has any concerns about the extent of your injuries or the validity of your claims, you could be forced to go through an administrative process to prove your entitlement to coverage. As part of that process, you may need to sit through an independent medical review.
If you were injured at work, the workers’ compensation lawyers at Ochoa & Calderón will help you through all steps of your workers’ compensation claim. We’ll investigate the circumstances of your workplace accident, gather the best evidence, negotiate with defendants and insurance companies, and fight for your right to full recovery for the harm you have suffered. We’re well-versed in navigating the complex legal system, including the independent medical review process. Call our Southern California workers’ comp legal team today to protect your rights and your future.
What Is the Independent Medical Review and How Does It Affect the Workers’ Compensation Process?
Independent Medical Review (IMR) is a process utilized by the California workers’ compensation system to resolve any disputes about the medical treatment of injured employees. The IMR is an administrative system, meant to streamline the review process and facilitate decision-making in a more efficient and consistent manner than resolving disputes through the court system.
The system proceeds as follows: When you file a request for medical treatment through the workers’ comp system, your claim will proceed through a “utilization review” (UR) process. The California Division of Workers’ Compensation (DWC) receives your claim and establishes a review panel to determine if the requested treatment is medically necessary. The UR will be conducted by physicians as well as non-physicians. Ultimately, the DWC will either approve the treatment or issue a letter to the claimant explaining the reason for any contrary decision.
If the claim is delayed, denied, or modified, the injured employee has the right to request a review of the decision. The review of that decision constitutes the IMR. The DWC will contract with an independent medical review organization to appoint medical professionals to conduct the IMR and render a decision as to whether the UR denial should be upheld or overturned.
Who Pays for the IMR?
The DWC contracts with an independent medical review organization to conduct the IMR for your claims. Thankfully, it’s your employer’s responsibility to cover the cost of the IMR, so long as they are legally required to provide workers’ comp.
An Experienced Workers’ Comp and IMR Attorney Can Boost Your Chance for Compensation
As with anything else involving insurance coverage, the system is stacked against the claimants. IMRs tend to side with insurance companies and uphold UR denials. Workers with seasoned legal representation on their side, however, have a better shot at getting their original claims approved and at having unfavorable UR decisions overturned. Your California workers’ comp lawyer can help you build your original filing, prepare for your IMR, and explore all of your other options for coverage.
Call a Riverside Independent Medical Review Lawyer Today
If you’ve been hurt on the job in Southern California and you have any difficulties in obtaining the benefits you are due, call Ochoa & Calderón for a free consultation on your claims. We only charge a fee after we are successful in recovering compensation for you. No recovery, no fee.