Utilization Review
Oct 28, 2024
Paduda (Unintentionally) Blasts CA Workers' Comp
A recent edition of Joe Paduda’s Managed Care Matters newsletter absolutely nails the systemic issues that plague California workers’ comp. The only twist? Mr. Paduda wasn’t ...
Oct 16, 2024
Sedgwick Removes 54% UR Denial Stat From Website
We knew it was only a matter of time. The question was how much time?Third-party administrator (TPA) Sedgwick Claims Management Services screamed the quiet part out lo...
Oct 10, 2024
Medicare Advantage & Workers' Comp: Why Providers Reject Both
Becker’sreports that hospitals and health systems across the nation are giving up on Medicare Advantage, terminating contracts and refusing to treat patients co...
Sep 26, 2024
CA Governor Vetoes UR Bill
California Governor Gavin Newsom vetoed California Senate Bill 636, which would have required that Utilization Review (UR) for private employers be conducted only by Californ...
Sep 20, 2024
Liberty Mutual Feeds UR Vendors (While CA Worker Waits for Care)
In California workers’ comp, Utilization Review (UR) is the process by which claims administrators decide whether or not to authorize the care recommended by an injured worke...
Sep 19, 2024
Sedgwick Boasts 54% Denial Rate for Injured Worker Treatment
Editor’s note: As predicted below, Sedgwick removed the 54% statistic from its marketing website, shortly after the publication of this article. Who coul...
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Sep 18, 2024
Liberty Mutual: 23-Month Wait for Surgery in CA
If you need proof of how dysfunctional California workers’ comp is—and that absurdly long claim durations have become the appalling standard—see the 23-month ordeal an injure...
Sep 17, 2024
CA SB 636 Demands CA-Licensed UR Physicians
California Senate Bill 636, which addresses a vital aspect of the Utilization Review (UR) process in workers’ comp, is on the Governor’s desk awaiting his signature.In...
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...
Feb 9, 2024
Will CA Clean Up Authorization/UR Issues?
When it comes to payer abuse of the authorization process in healthcare, the jig isn’t exactly up yet — but federal legislators and regulators seem to be catching on to priva...
Feb 8, 2024
CA Authorization & UR Confusion Reigns
Last week, we reported on the California Division of Workers’ Compensation (DWC)’s decision to delete an important FAQ from its website. Until the deletion, the FAQ affirmed ...
Jan 9, 2024
Albertsons Employee's Post-Amputation UR Nightmare
Two days before Christmas in 2022, an Albertsons Companies employee suffered “traumatic amputations” of three toes in a work accident. This worker lived alone on the t...