You must have obtained a 2nd and 3rd opinion before you request an Independent Medical Review. If you dispute the 3rd opinion physician’s determination you may file a request with the Workers’ Compensation Administrative Director for an Independent Medical Review. For information about filing an Independent Medical Review contact your claims examiner, or Department of Workers’ Compensation Medical Unit listed below.

Department of Workers’ Compensation Medical Unit
P.O. Box 71010, Oakland, CA 94612-7110
(510) 286-3700 or (800) 794-6900

The Administrative Director shall select an Independent Medical Reviewer with the appropriate specialty within 10 business days of receiving the application form. Selection of the Independent Medical Reviewer shall be based on the specialty of the treating physician, alternate specialties listed by you and the claims examiner, and information submitted on the Independent Medical Reviewer application.

During this process you must remain within the Medical Provider Network for treatment. You may receive treatment from a physician of your choice from within the network. If the Independent Medical Reviewer agrees with the diagnosis, diagnostic service or medical treatment prescribed by the treating physician, you must continue to receive medical treatment from physicians within the MPN.

If the Independent Medical Reviewer does not agree with the diagnosis, diagnostic service or medical treatment prescribed by the treating physician, you shall seek medical treatment with a physician of your choice either within or outside the MPN. If you choose to seek treatment from a physician from outside the MPN, the treatment is limited to the treatment recommended by the Independent Medical Reviewer or the diagnostic service recommended by the IMR.

If you wish to withdraw your request for an Independent Medical Reviewer you must do so in writing and addressed to the Administrative Director at the address:

Department of Workers’ Compensation Medical Unit
P.O. Box 71010, Oakland, CA 94612-7110
(510) 286-3700 or (800) 794-6900