The Evil Genius Of Utilization Reviews

A Utilization Review (UR) is the procedure for ensuring that the medical care provided to you, the injured worker, will be the cheapest and poorest in the state. It is required in all workers' compensation cases.

If you have been denied medical treatment based on UR, don't give up; we can help.

What You Need To Know

After a work injury, your primary treating physician or surgeon writes to the insurance company and requests authorization for a specific treatment using a very specific state mandated form.

The insurance company can then authorize treatment. Much more likely, however, is that they will send it to "utilization review" (UR) to determine if the recommended treatment is medically necessary.

Almost all of original treatment requests are sent to UR. This isn't surprising, since insurance companies do not like to pay if they are not required to. Further, in our experience the UR is not independent and generally recommends what is in the interests of the insurance company paying them.

Denied Treatment? You Have Only A Limited Time To Appeal.

The UR decision is final unless appealed within 30 days of receipt of an Independent Medical Review (IMR) notice. This is absolutely critical. If an appeal is not timely filed, the treatment will not be provided under any circumstance. If you hire us as your attorneys, we can appeal the denial of medical treatment when we receive the IMR request form.

If you have received an IMR request form and/or a notice of denial of treatment you should call 866-432-2133 or email our office. Make sure to advise our office that you have received the IMR request form and denial of treatment and that you wish to appeal.

We Know California Workers' Compensation Law And IMRs

As your attorneys, we intend to review the documents sent in by the insurance company and send additional documents as necessary. Your doctor can also send additional documents. There is a specific list of documents which need to be sent by the employer. What you send is optional, so a careful compiling of evidence to prove what medical treatment is right for you is essential.

You Can Fight Back

Here's what you, as our client, need to do to help get the medical care we think you deserve:

  • Call us immediately (you are under a deadline and we can only help you if you contact us as soon as possible). Reach us at 866-432-2133.
  • Ask your doctor to write an additional letter which highlights why the treatment requested comes under the MTUS (Medical Treatment Utilization Schedule) standards

Get A No-Cost, No-Risk Case Assessment

Ivancich, Martin & Costis, LLP, is the largest workers' compensation law firm in Contra Costa County and the Tri-Valley. We have two convenient office locations in Antioch and Dublin. Our lawyers do not charge for an initial consultation, and we only accept a legal fee if we get you benefits. There is no cost to you so you have nothing to lose, unless you delay. Call today to get started.