Article ID: 9f7094efc17fd3048bcc0712c35089161a0b1fc72504bc47354f0e37c888cafc
Source ID: secondary:businessinsurance.com
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URL: https://www.businessinsurance.com/california-comp-medical-reviews-rise-in-2025/
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California comp medical reviews rise in 2025 - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers California comp medical reviews rise in 2025 by Louise Esola Workers Comp , Workers Comp Cost Control May 21, 2026 California’s independent medical review program saw an increase in workers compensation medical disputes in 2025, while treatment denials were overturned at a lower rate than the prior year, according to a report released Tuesday. Maximus Federal Services, which administers the program, received 201,037 independent medical review applications in 2025 and issued 152,351 final determination letters, each addressing one or more medical necessity disputes, according to the report from the state Department of Industrial Relations and its Division of Workers’ Compensation. The number of applications rose 0.7% from 2024, while final determination letters increased 7.6%. Nearly 91% of unique filings were deemed eligible for review, slightly higher than in 2024. Independent medical review is the process used in California’s workers compensation system to resolve disputes over medical treatment requested by treating physicians but denied or modified through utilization review. The report said that Maximus issued decisions on average of six to seven days after receiving all required medical records. Of 152,243 standard independent medical review decisions issued in 2025, 13 were issued outside the statutory timeframe. Overall, treatment request denials were overturned 10.2% of the time, down from 12.7% in 2024. Program services had the highest overturn rate at 18.5%, followed by behavioral and mental health services at 18.3%, and evaluation and management services, at 16.8%. Pharmaceuticals remained the largest category of disputed treatment requests, accounting for 30.6% of all issues submitted for review, down from 32.7% in 2024. Opioids accounted for 21.5% of pharmaceutical requests, followed by topical analgesics at 18.9% and muscle relaxants at 15.8%. The report said utilization review denials of pharmaceutical requests were upheld 91% of the time. Among drug classes, antidepressants had the highest overturn rate at 24.1%, followed by nonsteroidal anti-inflammatory drugs at 18.9% and antiulcer agents at 18.3%. Medical Treatment Utilization Schedule guidelines continued to serve as the primary resource for determining medical necessity, the department said. 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