Insurance Code section 10169.5

(a)

After considering the results of a competitive bidding process and any other relevant information on program costs, the commissioner shall establish a reasonable, per-case reimbursement schedule to pay the costs of independent medical review organization reviews, which may vary depending on the type of medical condition under review and on other relevant factors.

(b)

The costs of the independent medical review system for insureds shall be borne by disability insurers pursuant to an assessment fee system established by the commissioner. In determining the amount to be assessed, the commissioner shall consider all appropriations available for the support of this article, and existing fees paid to the department. The commissioner may adjust fees upward or downward, on a schedule set by the department, to address shortages or overpayments, and to reflect utilization of the independent review process.

(c)

The commissioner may contract with the Department of Managed Health Care to administer the requirements of this article.

Source: Section 10169.5, https://leginfo.­legislature.­ca.­gov/faces/codes_displaySection.­xhtml?lawCode=INS§ionNum=10169.­5.­ (updated Jan. 1, 2001; accessed Oct. 27, 2025).

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Verified:
Oct. 27, 2025

§ 10169.5's source at ca​.gov