Utilization Review
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...
Sep 29, 2023
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...
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...