Before you request an Independent Medical Review with the California Department of Insurance, you are required to first file an appeal/grievance with the insurance company in an effort to resolve the issue(s). If you do not receive a satisfactory response after 30 days, then complete the Application for Independent Medical Review, attach copies of any important papers that relate to your complaint and mail to California Department of Insurance at the address shown on the application form. You may also attach additional sheets as necessary to explain and/or describe the situation and disagreement with your insurance company. We consider this information necessary to our review and within the powers and duties expressed in the California Insurance Code, Section 12921.3 and Section 10169. Please review our privacy statement regarding information we obtain from you.
You have the right to provide any information or documentation you believe will support your position in this review.
You may inspect the information you submit at any time as long as the department’s case is maintained. All original documents will be returned to you upon completion of our handling.
APPLICATION FOR INDEPENDENT MEDICAL REVIEW MAY BE SUBMITTED TO THE DEPARTMENT OF INSURANCE FOR THE FOLLOWING TYPES OF PROBLEMS:
Under the Independent Medical Review process, one or more physicians will determine these issues and their decision will be binding on the insurance company.
Please be aware that a copy of this Application for Independent Medical Review will be provided to the insurance company. Also, please be advised that: