April 08, 2025 – MedLegalNews – Sacramento, CA – DIR Releases 2024 IMR Report: The California Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have released the 2024 Annual Report on the state’s Independent Medical Review (IMR) program. Now in its twelfth year, the IMR process continues to serve as California’s primary method for resolving disputes over medical treatment in the workers’ compensation system.
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.
Read More from MedLegalNews.com
- Construction Company Cited $157,500 After Fatal Trench Collapse
- CA Attorney General Bonta Reaches $1.3 Million Settlement in Fake Health Insurance Case
- California Lawmakers Demand Answers Over $3.44 Billion Medi-Cal Loan
- CA Insurance Commissioner Reappoints Two to WCIRB Governing Committee
- Support Fire Recovery Efforts: California Invests $25 Million
Stay informed on medical-legal trends, utilization review reforms, and workers’ compensation law at MedLegalNews.com.