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After pandemic downturn, worker’s comp medical disputes up again in California



The pharmaceutical reduction was largely due to the adoption of the Medical Treatment Utilization Schedule (MTUS) Prescription Drug Formulary in 2018, and the Pain Management and Opioid Guidelines in 2017, said the CWCI.

The pharmaceutical change had the biggest impact, with the number of prescription drug disputes falling from 47.3% of all IMRs in 2017 to 33.3% in 2022. That trend continues this year, with data showing prescription drug disputes making up 32.6% of all disputes up to June.

Opioid claims have dropped from a third of pharmaceutical IMR claims in 2018, to less than a quarter as of this June.

Physical therapy workers’ comp disputes on the rise

Since 2018, IMR disputes related to physical therapy, injections, and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) have had the most significant increases, said the CWCI.

Physical therapy disputes around workers’ compensation have jumped from 10.3% to 13.4%, injection disputes from 9.0% to 12.1%, and DMEPOS rose from 7.1% to 8.9%

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