The Independent Medical Review Program

2 Who can request an Independent Medical Review? Any person who is insured by a health insurance company has the opportunity to seek an IMR whenever health care services have been denied, modified, or delayed by the health insurer if the decision was based in whole or in part on a finding that the health care service was not medically necessary or deemed to be experimental or investigational. As the insured, you can designate a person to act as your advocate and request an IMR if you are unable to do so. Also, a health care professional (such as your doctor) is allowed to join and assist you with the IMR request. It is necessary in most situations to go through the appeals/ grievance process with your health insurance company before applying for an IMR with the CDI. If the insurance company upholds its decision or has not provided a ruling within 30 days of filing the appeal/grievance, then you can file an IMR request. Your request for an IMR must be made within 6 months of the insurance company upholding its decision within the appeals/ grievance process. If special circumstances are present, the law allows the Insurance Commissioner to consider extending the filing deadline beyond six months. When can an Independent Medical Review be requested ?