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What is Utilization Review?

By Kenton Koszdin Law Office on March 19, 2013 | In Workers Compensation Claims

Utilization review (UR) is a process that employers or workers’ compensation claims administrators use to decide if the treatment prescribed by your doctor after an on-the-job injury is medically necessary. If the treatment is not found to be medically necessary, coverage for it may be denied.

UR evaluations rely on California’s medical treatment utilization schedule (MTUS), which lists evidence-based treatments for various types of injuries and illnesses. It also includes instructions on how treatment should be given and how long it should last in most cases. The MTUS can be viewed online.

If your doctor recommends a treatment that isn’t in the MTUS, it may be approved for coverage as long as it is based on scientific evidence that shows the treatment is useful for the type of injury or illness you suffered on the job.

How long a claims administrator may take to perform a UR depends on the type of UR being performed. If the UR occurs before you are treated, the claims adjuster typically has 5 days, but no more than 14. If it occurs after you are treated, the claims administrator typically has 30 days. These time periods may be shortened if treatment is urgent.

If you’ve been injured while on the job, please don’t hesitate to call the skilled southern California workers’ compensation attorneys at the Kenton Koszdin Law Office. We’ll help you with every step, from filing an initial claim to defending your rights to treatment and other benefits. Contact us today at (800) 438-7734 for a free and confidential case evaluation.

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