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Complex Regional Pain Syndrome: when insurers say no, reviewers often say yes

In 22 published external-review decisions involving complex regional pain syndrome, independent physician reviewers overturned the insurer’s denial 36.4% of the time.

Published decisions
22
2001–2026
Overturned
36.4%
8 denials reversed
How to use this in your appeal

These outcomes come from California’s external review program — an independent physician panel whose decision binds the insurer. Every state has an equivalent, and internal appeals succeed even more often. If your care for complex regional pain syndrome was denied, the published record says the denial is worth fighting.

SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY

Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.

Fighting a denial for complex regional pain syndrome? 36.4% won.

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