Electric Scooter denials: 9.0% overturned by independent reviewers
In 100 California IMR decisions from 2002 to 2025, reviewers overturned the plan 9 times (9.0%). In the last five years: 0.0% of 14. Denials reach IMR only when a member appeals all the way; read the caveats below before generalising.
By diagnosis
| Diagnosis category | Decisions | Overturned | Last 5 years |
|---|---|---|---|
| Orth/Musculoskeletal | 43 | 9.3% | 0.0% of 7 |
| CNS/ Neuromusc Dis | 15 | 20.0% | 0.0% of 1 |
| Immuno Disorders | 10 | 0.0% | 0.0% of 1 |
| Respiratory System | 7 | 14.3% | — |
| Endocrine/Metabolic | 6 | 0.0% | 0.0% of 2 |
| Morbid Obesity | 5 | 0.0% | — |
| Cardiac/Circ Problem | 5 | 0.0% | — |
By year (last five)
| Year | Decisions | Overturned |
|---|---|---|
| 2021 | 2 | 0.0% |
| 2022 | 2 | 0.0% |
| 2023 | 2 | 0.0% |
| 2024 | 4 | 0.0% |
| 2025 | 4 | 0.0% |
What the findings mention
| What the findings mention | Decisions | Overturned | All decisions here |
|---|---|---|---|
| Records did not supportThe findings say the documentation did not show what was needed (usually an upheld denial). | 31 | 0.0% | 9.0% |
| Published evidence citedThe findings refer to peer-reviewed or published evidence. | 10 | 30.0% | 9.0% |
| Guidelines or criteria citedThe findings cite guidelines, criteria or a standard of care. | 3 | 0.0% | 9.0% |
Keyword matches on the reviewer’s findings, not causes. A tag that appears mostly in overturned decisions is worth documenting in an appeal; it is not a guarantee.
From recent overturned decisions
“Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for a knee scooter. Ciufo and colleagues note that the knee scooter is a commonly used mobility device in the setting of unilateral below-knee immobilization to manage lower extremity injuries and elective surgery. The authors continue that the knee scooter assists patients in maintaining independence, performing daily activities, …”
“Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for a lightweight folding power operated vehicle (POV)/scooter for treatment of the enrollee’s Kennedy’s disease. Findings: The physician reviewer found that the request for a lightweight folding POV is medically necessary for treatment of the patient’s medical condition. The benefits of power-mobility devices are reported to include improved …”
“Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for a motorized scooter for treatment of the enrollee’s medical condition. Findings: The physician reviewer found that powered mobility can beneficial for well-selected individuals. The benefits of power-mobility devices are reported to include improved quality of life, an increased sense of freedom and improved self-esteem. Determining of who …”
- California only: these are decisions by independent reviewers under California's IMR program (plans regulated by the Department of Managed Health Care). Other states and self-funded employer plans use different reviewers and rules.
- Selection: only denials that a member took all the way to IMR appear. Most denials are never appealed, and the ones that reach an external reviewer are not a random sample.
- Overturned means the reviewer disagreed with the plan; it does not mean the treatment worked or that a similar request will be approved.
- Argument tags are keyword matches on the reviewer's findings. They describe what the findings mention, not why the case was decided.
- Categories are DMHC's own labels (treatment sub-category and diagnosis category); 'Other' is a catch-all and is excluded from rankings.
Source: California Department of Managed Health Care, Independent Medical Review (IMR) Determinations, Trend (CHHS Open Data). Public California government data; Apellica's aggregates and tags are CC BY 4.0.
Questions
How often were Electric Scooter denials overturned?
In 100 California IMR decisions from 2002 to 2025, reviewers overturned the plan 9 times (9.0%). In the last five years: 0.0% of 14.
What did the reviewers' findings mention in overturned cases?
The table on this page counts keyword matches in the findings: prior therapies tried, contraindications, guidelines cited, published evidence, whether the records supported the request. They describe what the findings say, not why the case was decided.
Does a California IMR result apply to my plan?
Only California plans regulated by the Department of Managed Health Care go to IMR. Other states and self-funded employer plans use different reviewers, but the reasoning is the same kind: criteria, documentation and alternatives. Use the findings as a guide to what to document.
Related: California appeal rights · California external-review reversal rate · The levers library · CSV
Independent reviewers reverse plans when the record answers the criteria. Upload the denial letter; a senior reviewer reads it within 24 hours and tells you in writing whether it can be appealed and how. $0 upfront, 10% of what is recovered, nothing if we do not recover. Not a law firm.