Friday, October 23, 2015

IMR... Again!

Maximus, the Independent Medical Review firm for disputed California workers' compensation medical treatment requests, is in the news again, this time for not itemizing all of the records reviewed in a determination.

When the firm started three years ago, documents reviewed were titled, dated, and the author identified.

Now, according to a review by WorkCompCentral reporter Greg Jones, Maximus has reverted to listing documents in a date range, which, attorneys for injured workers say, makes it impossible to determine whether there has been a plainly erroneous review - one of the five reasons under the Labor Code in which a second bite at the apple would be provided.

While that is a problem in itself, failure to itemize with detail just costs more money because if there is doubt about whether a particularly important document was reviewed then, at no cost to the injured worker or the attorney, but at a cost of $350 to the claims payer, a second review can unnecessarily inflate that loss cost expense.
Not again!

And we know what the fastest growing cost component in California work comp is...

An important potential benefit of IMR determinations, that is currently a missed opportunity, is educating the medical community via the determinations. If there were sufficient detail in the determination letters as to why, or why not, a particular treatment consideration decision was made then the community could adjust, and perhaps the quantity of IMR requests would go down.

But that is not how the system is set up.

Division of Workers' Compensation spokesman Peter Melton told Jones Thursday he was researching questions about how Maximus is identifying medical records.

I wrote a couple of posts ago that data is good, but there is a story behind the data that will either explain it, or contrast it.

This is one of those stories - and that the issue was brought to the attention of DWC via the story is demonstration that the data is not the end, but the beginning, of understanding.

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