How to Request IMR After a California UR Treatment Denial

Start with the exact written decision

This page explains the IMR application workflow. First identify the written UR decision, its service record, and the treatment it denies or modifies.

A treatment decision is different from a denial of the whole workers' compensation claim. If UR denied or modified a treatment request based on medical necessity, Labor Code section 4610.5 may provide the IMR process. Use the treatment-denial guide if you first need to sort out which document or issue you received.

Save the complete decision, IMR notice, envelope, email, or portal record. The request period generally runs 30 days after service of the written UR decision. It is 10 days only when the decision solely denies or modifies a request for a drug on the MTUS Drug List. A separate liability dispute or missing required notice can affect when the period begins under Rule 9792.10.1.

Complete the current DWC Form IMR

Use the current Application for Independent Medical Review, DWC Form IMR. Include a copy of the written UR decision and keep proof of what you send.

Rule 9792.10.1 requires an eligible IMR request to use the current DWC Form IMR. The form is submitted to the Administrative Director or designee by mail, fax, or electronic transmission with a copy of the written decision denying or modifying the treatment request. At filing, the employee must concurrently provide the claims administrator a copy of the signed DWC Form IMR without the written decision.

Do not rely on a generic form name or an old address. The current form and written notice identify the application and delivery instructions. For a related explanation of the IMR process after assignment, see the IMR process guide.

Responding to record requests

After assignment, both the claims administrator and eligible worker-side participants can have record-submission duties and opportunities.

Rule 9792.10.5 requires the claims administrator to submit specified records and information after assignment and to provide the required document notice to the employee or representative. The employee, representative, treating physician, or another eligible party may submit the treating physician's recommendation and reasonable information supporting medical necessity within the applicable period. Newly developed relevant records held by either side must be forwarded as the rule requires.

The independent review organization may request additional appropriate documentation or information. Respond to an actual request using the timeframe and service instructions in the request. Keep a copy of the request, response, and delivery evidence. The rule allows records from more than one source, so do not assume that the initial application is the only material the organization may receive.

What happens next

The application request period is different from the time for an IMR determination. Rule 9792.10.6 measures a regular determination from the organization's receipt of the application and supporting documentation. The separate process guide explains those determination rules and the later limited petition procedure. An application does not predict whether the requested treatment will be found medically necessary.

The current official application also explains mailing-related additions to filing time. Check the form, service method, and instructions before calculating the deadline for a specific notice.

Prepare a focused file

The California workers' compensation consultation checklist can help organize the written UR decision, application, medical records, and a short timeline. Yazdchi Law is based in Palmdale. Call (661) 273-1780 or use the contact form to ask whether the firm can assess a California workers' compensation matter. Each matter is assessed individually.

Official IMR sources

• IMR request rules
• Medical-record submissions
• Determination standards and timing
• Petition after an IMR determination
• Current official DWC Form IMR (PDF)