California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.5.1 - Utilization Review Standards › Section 9792.10.4 - Independent Medical Review - Assignment and Notification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The independent review organization
					 delegated the responsibility by the Administrative Director to conduct
					 independent medical review pursuant to Labor Code section
					 139.5 (IMRO)
					 may consolidate two or more eligible applications for independent medical
					 review by a single employee for resolution in a single determination if the
					 applications involve the same requesting physician and the same date of
					 injury.
(b) Within one business day
					 following receipt of the Administrative Director's finding that the disputed
					 medical treatment is eligible for independent medical review, the independent
					 review organization delegated the responsibility by the Administrative Director
					 to conduct independent medical review pursuant to Labor Code section
					 139.5 shall
					 notify the employer, employee, if the employee is represented the employee's
					 attorney, and the requesting physician in writing that the dispute has been
					 assigned to that organization for review. The notification shall contain:
(1) The name and address of the independent
					 review organization;
(2)
					 Identification of the disputed medical treatment, including the date of the
					 request for authorization (if available), the name of the requesting physician,
					 and the date of the claims administrator's utilization review
					 decision.
(3) The date the
					 Application for Independent Medical Review, DWC Form IMR, was received by the
					 Independent Review Organization.
(4) A statement whether the independent
					 medical review will be conducted on a regular or expedited basis.
(5) For regular review, a statement that
					 within fifteen (15) calendar days of the date designated on the notification,
					 if the notification was provided by mail, or within twelve (12) calendar days
					 of the date designated on the notification if the notification was provided
					 electronically, the independent review organization must receive the documents
					 indicated in section
					 9792.10.5. For the notification
					 provided to the claims administrator, the statement shall provide that,
					 pursuant to Labor Code section
					 4610.5(i),
					 in addition to any other fines, penalties, and other remedies available to the
					 Administrative Director, the failure to comply with section
					 9792.10.5 could result in the
					 assessment of administrative penalties up to $5,000.00.
(6) For expedited review, a statement that
					 within twenty-four (24) hours following receipt of the notification the
					 independent review organization must receive the documents indicated in section
					 9792.10.5. For the notification
					 provided to the claims administrator, the statement shall provide that,
					 pursuant to Labor Code section
					 4610.5(i),
					 in addition to any other fines, penalties, and other remedies available to the
					 Administrative Director, the failure to comply with section
					 9792.10.5 could result in the
					 assessment of administrative penalties up to $5,000.00.