Utilization review is a method that enables the workers’ compensation insurance claims administrators to review proposed medical treatment before it occurs. That may sound harmless, but in reality, insurance companies often use this process to deny needed medical treatment to injured workers.
If you have been denied medical treatment, there may be ways around the utilization review process. At Boxer & Gerson, LLP, we have a comprehensive understanding of utilization review and its rules. Our attorneys bring great diligence and experience to help our clients obtain all the medical care they need to recover to the greatest possible degree from their injuries.
If your workers’ compensation insurance company has denied you medical care or a medical testing procedure, contact our firm.
In a typical case, a treating physician may put in a request for an MRI, which then is sent to the utilization review doctor. After 2-3 weeks, the request is often denied. Meanwhile the injured person’s condition has not improved—or gotten worse.
Under California law, an insurance adjuster can send a request for treatment to a utilization review doctor who never sees you or treats you. Often the doctors assigned to utilization review have a general bias toward denying treatment or tests. The result is that needed medical treatment or tests to better diagnose your problem are often denied or delayed. This can leave you not only frustrated, but perhaps further incapacitated as your injury is left untreated.
Boxer & Gerson, LLP specializes in helping injured workers get the medical tests and treatment they need. Insurance companies must abide by certain regulations and timeframes in providing utilization review of treatment requests. We know how the system works, and we can challenge treatment denials.
In every case, our firm works with great focus and resolve, using our expertise in the law and medical science to protect our clients’ rights. We take pride in using our knowledge and experience to help you get all of the medical care and services you deserve.
Contact Boxer & Gerson, LLP for a free, no-obligation consultation about your workers’ compensation case.