Utilization Review

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...

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...