Independent Medical Review

A process, independent of all affected parties, to determine if a health care service is medically necessary, medically appropriate, experimental or investigational. Independent review typically occurs after all appeals mechanisms available within the health benefits plan have been exhausted. Independent medical review is often referred to as external review. According to critics, independent medical review is generally limited to the completion of a medical history by the claimant; a review of available documents provided by the treating doctor; a brief medical exam; the reviewing doctor asking question about the claimant's symptoms and recording his or her impressions regarding the case and describing the treatments required. Independent medical reviews are also used for determinations used by insurance carriers in connection with paying medical bills and settling, arbitrating and litigating claims over wage-replacement benefits. Furthermore, independent medical reviews address questions regarding the final degree of disability.