Which process resolves objections to medical treatment decisions under Section 4610?

• A. Independent Medical Review
• B. Utilization Review
• C. Arbitration
• D. Litigation

Answer: (A)

Independent Medical Review is the mechanism used to resolve objections to medical treatment decisions under Section 4610. When a worker or the plan disagrees with a treatment decision after the initial utilization review, IMR kicks in to provide an independent medical assessment. A panel of physicians with the appropriate specialty reviews the medical records, the proposed or denied treatment, and applicable evidence-based guidelines to determine whether the treatment is medically necessary and appropriate. The IMR decision is binding on the payer and serves as the final resolution of the treatment dispute within the self-insured plan framework, with limited avenues for court review if needed. This process sits alongside utilization review as the actual pre-authorization step, and it is distinct from arbitration or litigation, which are different dispute-resolution paths not specifically designed to settle 4610 medical treatment objections.