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CA Supreme Court Decides IMR Challenge

The state’s Supreme Court ruled it not hear a case challenging the constitutionality of California’s independent medical review (IMR) system created by the SB 863 reforms. The court rejected the case which also sought court review of an underlying utilization review (UR) decision.

Courts continue to uphold this fundamental element of California’s most recent set of workers' comp reforms.

The case, Ramirez v. Workers' Compensation Appeals Board/State Department of Health Care Services, the plaintiff argued that the UR decision in his case was defective. The UR physician determined that additional acupuncture treatments were not necessary. IMR upheld the denial.

Ramirez maintained that the UR reviewer failed to follow the medical treatment utilization schedule (MTUS).

Most importantly, he also challenged the constitutionality of preventing the WCAB from making medical necessity decisions as it had done in the past. The petition also challenged the provision in SB 863 that keeps the identity of the IMR reviewers confidential

The arguments failed at every level and now has failed in the state’s highest court. The court did not elaborate on its decision to deny the petition for review.

IMR / UR is the law.


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