Utilization Review

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...

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...

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...

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...

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...

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...

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 ...

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...

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 #7: Truly Unbelievable Incompetence

Employees, taxpayers, and moral human beings should be outraged by Utilization Review (UR) abuse inflicted on a state employee by the State Compensation Insurance Fund (SCIF)...

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...