Request for Authorization
Aug 21, 2024
CCCSIG Adds Bogus "Expiration Date" to UR Approval
Let’s be absolutely clear: in California workers’ comp, treatment authorization does not expire. Once Utilization Review (UR) determines that treatment is authorized, there i...
Apr 2, 2024
CA UR: AmTrust & Genex Deny Care With ODG (Again)
What suffering must befall injured workers before California bothers to enforce its meager Utilization Review (UR) requirements?When considering which treatments are n...
.gif)
Nov 8, 2023
Sedgwick's UR Obstacle Course Delays Care
Welcome to California workers’ comp, where the law requires two doctors to do the job of one:A treating physician to heal the injured worker A Utilization Revie...
Sep 29, 2023
SCIF Inept UR #6: Non-MTUS Guidelines Strike Again
Once again, State Compensation Insurance Fund (SCIF) and EK Health denied surgery for an injured worker by citing unadopted, alternative treatment guidelines outside of Calif...
Sep 27, 2023
SCIF Inept UR #5: EK Health Ignores MTUS, Denies Surgery
Why is it so difficult to get treatment for a work-related injury? At least in California, most of the answer is a broken UR system that allows insurers to withhold potential...
.gif)
Sep 15, 2023
SCIF Inept UR #4: IMR Rules Favor Insurers
In recent articles, we’ve shared the details of State Compensation Insurance Fund (SCIF)’s denial of continued care for an injured worker on false grounds, and ...
Sep 13, 2023
SCIF Inept UR #3: IMR Offers No Hope for Injured Worker
In California workers’ comp, the insurer has the final say over an injured worker's medical care.So what if the insurer gets it wrong? What if the insurer denies appro...
Sep 12, 2023
SCIF Inept UR #2: Bungled Medical Records Strikes Again
Once again, the consequences of inept Utilization Review (UR) fall on an injured worker.EK Health, conducting UR on behalf of State Compensation I...
Sep 6, 2023
SCIF: Inept Utilization Review Delays Care for Injured Worker
We write often about the systemic issues surrounding Utilization Review (UR) in California and the constant struggle of providers to obtain authorization to tre...
Aug 22, 2023
Provider UR Data Belies Rosy Insurer Claims
At a recent California Division of Workers’ Compensation (DWC) meeting, a representative from the California Workers’ Compensation Institute (CWCI) — an insurers’ organizatio...
Aug 15, 2023
RFA: UR Decision Data 2023
On Friday, a California Workers’ Compensation Institute (CWCI) representative reportedly cited a 95% approval rate for medical treatments requested by California providers. T...
Jul 13, 2023
CA Adjuster Describes Injured Workers' Nightmare Scenario
Today we recount a too-familiar story that starts with a workplace injury and ends with an injured worker in collections — all because California can’t muster the stomach to ...