Denied Medical Treatment in California Workers’ Comp: Understanding UR & IMR

June 17, 2026

When you are hurt at the workplace, medical treatment can make all the difference in your recovery. But in workers’ compensation cases, a doctor’s recommendation does not always mean the treatment will be approved right away. If the insurance company questions whether the care is medically necessary, the request may go through Utilization Review, often called UR.

For many injured employees, a denied treatment request can feel frustrating and unfair, especially when they are dealing with pain, missed work, and uncertainty about the claim. The good news is that denial is not always the end of the road. California has a process called Independent Medical Review, or IMR, that may allow the disputed treatment request to be reviewed by an independent physician. Understanding the basics of UR and IMR can help your work comp attorney in Los Angeles prepare for what happens next.

Why medical treatment gets reviewed in workers’ comp?

In a workers’ compensation claim, medical care is generally supposed to be reasonable and necessary to treat the job-related injury. When a treating doctor requests certain care, such as physical therapy, medication, imaging, injections, surgery, or specialist treatment, the request may be reviewed before approval.

This review process is not the same as a regular doctor’s visit. It is a claims process used to decide whether the recommended care meets work comp medical guidelines.

Step 1: Your doctor submits a treatment request

The process often begins when your treating doctor submits a request for authorization. This request explains the treatment being recommended and why the doctor believes it is needed for your work injury.

The request may include medical records, exam findings, test results, or details about your symptoms and progress. The stronger and clearer the medical support is, the easier it may be for the reviewer to understand why the treatment is being requested.

Step 2: The request goes through Utilization Review

UR is the process used by the claims administrator to decide whether the requested treatment is medically necessary. The reviewer looks at the doctor’s request and compares it with applicable medical treatment guidelines.

UR may approve the request, modify it, delay it, or deny it. For example, a reviewer may approve fewer therapy visits than requested, ask for more information, or decide that the treatment does not meet the required standard at that point in the case.

Step 3: You receive a decision on the treatment

If the treatment is approved, care may move forward through the workers’ compensation system. If the treatment is denied or modified, the written decision should explain the reason for the decision and provide information about possible next steps.

This is where many injured workers feel stuck. A denial can be upsetting, but it is important to read the decision carefully. The reason for the denial may affect whether more medical documentation is needed or whether the issue should move to Independent Medical Review.

Step 4: Independent Medical Review may be requested

IMR is used when there is a dispute over medical treatment after UR denies or modifies a request. Instead of having the dispute decided in the usual court process, IMR allows an independent physician reviewer to evaluate whether the treatment should be authorized.

The IMR process is focused on medical necessity. The reviewer considers medical records and treatment guidelines to decide whether the disputed care is appropriate for the injury.

Step 5: Deadlines & paperwork matter

After a UR denial or modification, injured employees should pay close attention to the paperwork they receive. IMR requests are time-sensitive, and missing a deadline can affect the ability to challenge the treatment decision.

The notice may include instructions about how to request IMR and what documents need to be submitted. Because these forms and deadlines can be confusing, it’s crucial to turn to our methodical lawyers for legal guidance before moving forward.

Step 6: The IMR decision can affect your care

Once IMR reviews the dispute, it may uphold the UR decision or overturn it. If IMR overturns the denial, the treatment may be authorized. If IMR upholds the denial, the requested treatment may remain denied unless there is a new medical basis or a later change in condition.

This decision can have a major impact on recovery, especially when the requested care involves pain relief, mobility, surgery, or continued treatment.

Who has a reputation as the leading work comp attorney in Los Angeles & the area?

Whether you were injured while working in South Bay or anywhere else in the wider LA area, the LA Accident Pros team is here to help you stay positive and fight for what you’re entitled to by law. If you’re unsure about your recovery, your benefits, and what to do next, don’t worry. We’ve handled thousands of similar cases and come out with millions worth in benefits for our clients.

Looking for answers on how a QME report can shape your case, what happens if a doctor clears you for work too soon, or how immigration status affects your workers’ comp protections? Just arrange a free consultation with our resourceful team, and we won’t waste a minute more to get your case off the ground. We’re here to protect your rights and your best interests, so call us without delay!