A new report this month from the California Workers’ Compensation
Institute reveals that nearly 90% of all disputed workers' compensation
utilization review decisions are upheld during the independent medical
review process. It was also found that a significant portion of the disputed
decisions involved prescription medications.
Insurance Journal reports, CWCI officials believe the findings—culled from 2015 statistics—prove
that the relatively new California worker's comp review system is
"steady" and "very stable." "It tells us that
there is a consistent character in the decisions that are being made by
the independent medical review," said Alex Swedlow, president of the CWCI.
Utilization reviews are used to monitor the health of worker's compensation
claimants. When these reviews alter or terminate any part of a claimant's
treatment, they and their doctor have the option to dispute the decision
by applying for an independent medical review by assigned, impartial doctors.
Judging by the recent 2015 data, of the 300,000 IMR cases serviced last
year, only about 10% were reversed in the workers' favor.
A Focus on Prescriptions
The CWCI has also identified the source and nature of many of the disputed
utilization review decisions. According to the findings, a "small
circle of doctors" are responsible for a sizable portion of disputes
over prescription medications. Swedlow confirmed that nearly 50% of overall
disputes concerned prescriptions.
While there is a concern over the high number of prescription medication
disputes, many are hopeful about the Assembly Bill 1124. Passed and signed
last year, Assembly Bill 1124 will create a statewide drug formulary for
workers' comp claims by next year. The formulary will help create
standards for medication prescriptions and regulate how long claimants
should be on anyone particular drug. "It’s the wish and the
hope of the legislative intent in AB 1124 that our state-mandated formulary
will help eliminate a large layer of these conflicts," Swedlow told
If you are a worker who has been hurt on the job and needs assistance with
your workers' compensation claim, we invite you to contact us at the
Law Offices of Wax & Wax. Our experienced and award-winning Glendale workers' compensation
attorneys understand how sensitive and discerning California's workers'
comp system is and have helped countless clients cut through the red tape
and recover the relief they deserve.
Don't hesitate to put proven workers' comp advocate by your side
for this process. Call 818.946.0608 today to tell us your story.