DIR, DWC releases Independent Medical Review (IMR) report for 2025

NEWSLINE

The Department of Industrial Relations (DIR) and its Division of Workers' Compensation (DWC) have released the annual report on the Department's Independent Medical Review (IMR) program.

IMR is the medical dispute resolution process for California's workers' compensation system that resolves disputes over medical treatment for injured workers. The report summarizes IMR activity in 2025, the thirteenth year since the program was implemented.

The organization that administers the program, Maximus Federal Services, Inc., received 201,037 IMR applications and issued 152,351 final determination letters, each addressing one or more medical necessity disputes. Throughout the year, the organization issued decisions an average of six to seven days after receiving all required medical records.

Highlights from the report include:

• Nearly 91% of all unique IMR filings were deemed eligible for review, slightly higher than the percentage in 2024.
• Pharmaceutical requests accounted for 31% of all treatment requests submitted for IMR, representing a slightly smaller share of total service requests than in previous years.
• Opioids comprised 22% of all pharmaceutical requests.
• Treatment request denials were overturned at an overall rate of 10.2%, down from 12.7% in 2024. Program services, behavioral and mental health services, and evaluation had the highest overturn rates.
• Guidelines in the Medical Treatment Utilization Schedule continued to serve as the primary resource for determining medical necessity.

The report is posted on the DIR website: 2026 Independent Medical Review (IMR) Annual Report: Analysis of 2025 Data.

DIR's Division of Workers' Compensation monitors the administration of workers' compensation claims and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.