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. 38, September 20, 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:
(c) Review conducted on a regular basis shall be converted into an expedited review if, subsequent to the receipt of the Application for Independent Medical Review, DWC Form IMR, the independent review organization receives from the employee's treating physician written certification with supporting documentation verifying that the employee faces an imminent and serious threat to his or her health as described in section 9792.6.1(j). The independent review organization shall immediately notify the parties by the most efficient means available that the review has been converted from a regular review to an expedited review.
1. New
section filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to
Government Code section 11346.1(d) (Register 2013, No. 1). A Certificate of
Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be
repealed by operation of law on the following day.
2. New section
refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013, No. 27). A
Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency
language will be repealed by operation of law on the following
day.
3. New section refiled 9-30-2013 as an emergency; operative
10-1-2013 (Register 2013, No. 40). A Certificate of Compliance must be
transmitted to OAL by 12-30-2013 or emergency language will be repealed by
operation of law on the following day.
4. Certificate of Compliance
as to 9-30-2013 order, including amendment of section, transmitted to OAL
12-30-2013 and filed 2-12-2014; amendments effective 2-12-2014 pursuant to
Government Code section 11343.4(b)(3) (Register 2014, No.
7).
Note: Authority: Sections 133, 4603.5 and 5307.3, Labor Code. Reference: Sections 4062, 4600, 4600.4, 4604.5, 4610 and 4610.5, Labor Code.