April 08, 2025 | Sacramento, CA — MedLegalNews.com – The DIR IMR Report 2024 from the California Department of Industrial Relations (DIR) provides detailed insights into the state’s Independent Medical Review (IMR) program. According to the DIR IMR Report 2024, the process continues to serve as California’s primary method for resolving disputes over medical treatment in the workers’ compensation system, highlighting trends in eligibility, decision timelines, and treatment patterns.
Steady Volume, Faster Decisions
In 2024, Maximus Federal Services, Inc., the Independent Medical Review Organization (IMRO), received 199,651 IMR applications. From those, it issued 141,621 Final Determination Letters, each addressing one or more disputed treatment requests. Importantly, the IMRO delivered decisions within six to seven days after receiving all relevant medical records, reinforcing its commitment to timely resolutions.
Eligibility Rates and Treatment Patterns
Nearly 90% of all unique IMR filings qualified for review, a figure slightly below 2023’s eligibility rate. Pharmaceutical requests made up 33% of all services reviewed—a modest increase compared to previous years. Among those, opioid-related disputes represented 24%, continuing a well-documented trend of elevated concern over prescription drug management in workers’ comp. DIR Releases 2024 IMR Report
More Denials Overturned
The data also show a notable shift in outcomes: IMR reviewers overturned treatment denials in 12.7% of cases, up from 10.2% in 2023. This change suggests that more injured workers are successfully challenging UR decisions. The services most likely to be approved on appeal included:
- Evaluation and Management services
- Functional Restoration programs
- Brain Injury rehabilitation programs
- Weight loss interventions
- Behavioral and mental health services
As these figures indicate, providers are gaining some ground in contested areas involving comprehensive care and recovery.
MTUS Guidelines Remain the Cornerstone
Throughout 2024, reviewers continued to rely heavily on the Medical Treatment Utilization Schedule (MTUS) when determining medical necessity. Accordingly, both applicants and claims administrators must align their documentation and clinical justifications with these standards to improve outcomes.
Legal and Policy Implications
From a legal standpoint, the rising overturn rate may reflect increased scrutiny of UR decisions and more robust applicant-side advocacy. Consequently, defense attorneys and claims professionals should evaluate whether their utilization review processes comply not only with statutory timelines but also with evolving standards of care.
Additionally, the surge in pharmaceutical disputes—particularly those involving opioids—highlights the need for careful medication management protocols and defensible clinical reasoning.
Finally, as the state continues to refine its dispute resolution systems, stakeholders across the medical-legal landscape should expect further reforms aimed at balancing cost containment with timely access to care.
The full 2024 IMR Report is available now on the DIR website.
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FAQs: DIR IMR Report 2024
What is the purpose of the DIR IMR Report 2024?
The DIR IMR Report 2024 provides data on California’s Independent Medical Review process, showing trends in treatment disputes, overturn rates, and system performance.
How many IMR applications were filed in the 2024 report?
According to the DIR IMR Report 2024, more than 199,000 IMR applications were submitted, with over 140,000 final determination letters issued.
Why did the overturn rate increase in the DIR IMR Report 2024?
The report shows a rise in overturned denials due to stronger medical documentation and advocacy, leading to more successful challenges of utilization review decisions.
How does the DIR IMR Report 2024 affect claims professionals and attorneys?
Legal and claims teams can use insights from the DIR IMR Report 2024 to strengthen compliance, improve documentation, and anticipate reform impacts on medical necessity reviews.