Utilization Review
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...
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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 11, 2023
UR: An Open Letter to CA Residents
Dear California Readers,One of your neighbors experienced a significant head injury while repairing California highways. This individual has diminished cognitive abili...
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 11, 2023
California DWC - Division of Wretched Compensation
Immediately after an employee reports a work-related injury, the employer’s claims administrator is allotted up to 90 days to accept or reject liability for the reported inju...
Jun 20, 2023
Medical Director: CA Workers' Comp "Subsidizes Corruption"
Recently, the Medical Director of a large medical group sent an email to daisyBill, explaining their decision to "opt out" of treating injured workers in California. T...
Jun 7, 2023
5 Ways the RFA System Burdens Providers
In California, injured workers’ access to care depends directly on how physicians manage the state’s onerous authorization and Utilization Review (UR) requirements.
Jun 6, 2023
Missing UR Decisions (and Other RFA Problems) Solved
If your practice treats injured workers, you can’t get reimbursed without proof of authorization. Fortunately, California makes submitting Requests for Authorization (...