IMR: getting a denied treatment reviewed

When IMR applies

Independent medical review resolves disputes over a utilization review decision that denies or modifies a treatment request. It is the employee’s remedy; the requesting physician may join or assist (8 CCR §9792.10.1(c)).

The window

The application must be filed “within 30 days of service of the written utilization review determination” — or within 10 days where the decision concerns only a drug on the state’s formulary drug list (§9792.10.1(a)).

If the claims administrator is also disputing liability for reasons other than medical necessity, the 30 days do not begin until it serves notice that the liability dispute is resolved (§9792.10.1(e)(1)).

What gets filed

The application is DWC Form IMR (Rev. 04/01/2026), submitted with a copy of the written UR decision; the employee concurrently gives the claims administrator a copy of the signed form without the decision (§9792.10.1(b)).

An expedited request needs the treating physician’s written certification that the employee faces an imminent and serious threat to health, unless the UR decision was itself expedited (§9792.10.1(d)).

The physician may submit documents on the employee’s behalf and respond to the review organization’s inquiries (§9792.10.1(c)(1)(B)).

Before you re-request

A new request for a treatment that was denied, and upheld at IMR, should document what has changed clinically since the denial.

How ChironAI™ OM helps

A daily sweep opens an appeal record for IMR-eligible UR decisions and sends tiered deadline alerts; Chiron drafts the rationale sections from the case record for the physician to edit; the packet is assembled as one finalized, hashed PDF. OM also warns before a treatment already denied and upheld is requested again.