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Understanding the Utilization Review Process

Being injured at work is difficult. Depending on how severe your injuries are, you may be missing a lot of work and be facing a lengthy and painful recovery. However, many people find further pain and frustration in trying to receive the treatment they need. Utilization review is the main culprit for the delay and denial of necessary treatment.

What Is Utilization Review?

Utilization review, essentially, is the approval process every treatment must go through when you are being treated for a work-related injury. Your doctor will send proposed treatments to utilization review, and a panel of qualified physicians will determine if the requested treatments are medically necessary. Once they review your case and the doctor’s recommendation for treatment, they will either approve your treatment or deny it. This process may seem straightforward on paper, but it often turns out to be far more complicated.

Recently, utilization review has been brought under scrutiny for a number of reasons. Injured workers find that their treatments are being delayed considerably or simply denied. Critics have also pointed out a potential bias in the system. The physicians who perform the utilization review are employed by the insurance companies, which may prevent them from making fair assessments regarding the treatments being requested.

What if My Treatment Is Denied?

If utilization review denies a treatment that is essential to your recovery, you are able to request a review of that decision. The process that follows is called an Independent Medical Review (IMR). Your request for treatment will be reevaluated by an expert independent medical professional. Because this physician is external, he or she could potentially be less biased than the utilization review doctors.

If you believe you have been denied necessary medical treatment, contact the Central Valley workers’ compensation attorneys at Berry, Smith & Bartell. Our firm is dedicated to protecting the rights of injured workers in Bakersfield, Fresno, and Santa Maria.

We offer a free initial consultation. Contact us today!

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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