Utilization Review

Workers’ Compensation insurance companies in California are required to have a utilization review program to make sure that injured workers receive the necessary treatment to maximize their recovery from an injury. Most of the requested medical procedures are approved by either the claims adjuster or the nurse case manager. A denial of medical treatment must be done by a California-licensed physician who has established themselves as having the expertise in the administration of workers’ compensation claims and properly establishing the medical necessity, safety and appropriate care for treating an injury. All treatment denials can be appealed for further review.