The Independent Medical Review Program

When the IMR organization has completed its review of your particular case, they will have determined whether the disputed health care service is medically necessary. This determination is based upon your specific medical needs and any of the following factors: • Peer-reviewed scientific and medical evidence regarding the effectiveness of the contested health care service • Nationally recognized professional standards • Expert opinion • Generally accepted standards of medical practice. • Treatments that are likely to be effective for your medical condition rather than other treatments that are not. What are the criteria used in an Independent Medical Review determination? 6