They denied my MRI

Your doctor ordered imaging. Utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. said no. Here is what actually happens next.

Two clocks. Start them today. 30 days to file for Independent Medical Review from the date the denial was served. (Only 10 days if your dispute is about drugs on the MTUSMTUS Medical Treatment Utilization Schedule. California’s treatment guidelines. Four of them — shoulder, elbow, hand/wrist/forearm and traumatic brain injury — were replaced January 2, 2026. Drug List — not the case for imaging, but worth knowing.) Check the envelope first: if the claims administrator did not enclose the IMR application form and an addressed envelope, the clock never started.

Your actual odds

Diagnostic testing and imaging are overturned at IMR 13.7% of the time — the fourth-best category in the system, and meaningfully better than the 10.2% average across all treatment types.

That is still not good odds, and we are not going to pretend otherwise. But imaging is one of the categories where the appeal is genuinely worth filing on its own merits, rather than purely to preserve the issue.

Do these four things

1. File the IMR application. Always, and on time. It costs you nothing, the employer pays for the review, and not filing forfeits the issue permanently.

2. Submit your own documents. You are entitled to, and almost nobody does. The reviewer decides on a paper record and never examines you — so what is in the file is your case. Send your physician’s rationale, prior imaging, functional findings, and documentation of failed conservative care.

3. Have the denial checked for timeliness. This matters more than the appeal itself, and here is why: an IMR decision is the last word on medical necessity, and even a successful appeal of one to the Appeals Board produces a second IMR, not an authorization. But if the underlying utilization review was untimely, the denial is invalid and a judge — not an anonymous reviewer — decides whether you get the MRI. In Giron v. KDF Forestry (April 2026), a UR denial was struck because the carrier extended the deadline by phone call without the required written notice. The full checklist is here.

4. Talk to your doctor about the resubmission. Imaging denials frequently turn on the MTUS requiring documented conservative care first, or specific red-flag findings. A resubmission that cites the guideline and explains why you fall outside it is a different request than one that simply asks again. Note that a denial binds for 12 months as to the same treatment absent a documented material change in the facts — and § 4610(k) applies that bar to another physician in your doctor’s own practice group as well, so asking your doctor’s partner instead does not restart anything.

Why imaging gets denied

Almost always the MTUS. The guidelines generally call for a period of conservative treatment before advanced imaging, absent red flags — progressive neurologic deficit, suspected fracture, infection, or malignancy. A denial usually means the reviewer did not see documentation of either.

Note that X-rays are excluded from the imaging category that requires prospective review during the first 30 days after injury. Other imaging is not.

Frequently asked questions