Request for Authorization

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...

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 ...

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...

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...

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...

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...

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...