Request for Authorization

CA Employers Need to Know: Is It the Injury or the UR System?

Last year, California raised employers’ workers' comp premiums by 8.7% while other states continued to cut rates, some for over a decade straight. Across the nation, premiums...

Does CA Workers’ Comp Cause Secondary Psych Injuries?

New research illuminates a serious problem for injured workers: secondary psychological injuries resulting from the sheer hardship of navigating workers’ comp systems....

CA's "Cost Control" Mechanisms May Be the Most Expensive Parts of the Claim

Employers in California pay more for workers' comp coverage than in almost every other state, and the gap is widening. In our view, thereason isn't provider or ...

CA DWC's UR Audits: A Keyhole View of a Statewide Crisis

As early as 2016, California legislators recognized the potential for payers to abuse Utilization Review (UR), the process by which payers decide whether to deny or approve t...

Zurich: Vague Authorization Creates More Treatment Friction

Insurer Zurich North America offered a classic example of the bureaucratic absurdity that plagues California’s treatment authorization process, issuing a baffling, time-bound...

CA RFA Hell: Affirmative Cites the Most Cynical Excuse Yet to Deny Care

What’s the most absurd, bureaucratic, procedurally abusive excuse a claims administrator ever used to deny care to an injured worker?We’ve seen our share of bad-faith ...

An Open Letter to CHSWC re: UR Abuse (cc: Governor Newsom)

To the Members of the Commission on Health and Safety and Workers’ Compensation (CHSWC)CC: Governor Gavin NewsomRE: California’s Broken Utilization Review Syste...

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...

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...

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...

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...

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...