The program that claims administrators use to make sure that the treatment you receive is medically necessary is known as utilization review (UR). It is required by law that all claims administrators have a utilization review program to decide whether or not to approve the medical treatment recommended by your doctor. California has rules about how a UR must be conducted. If you feel that the UR company that is reviewing your doctor’s plan is not following the state rules you can file a complaint with the Division of Workers’ Compensation. You have the right to be seen on an expedited basis by a workers’ compensation administrative law judge if there is a dispute over your medical care in order to resolve the dispute. 

 


Q: What is California Workers Compensation Utilization Review?

A:

The program that claims administrators use to make sure that the treatment you receive is medically necessary is known as utilization review (UR). It is required by law that all claims administrators have a utilization review program to decide whether or not to approve the medical treatment recommended by your doctor.

California has rules about how a UR must be conducted. If you feel that the UR company that is reviewing your doctor’s plan is not following the state rules you can file a complaint with the Division of Workers’ Compensation.

You have the right to be seen on an expedited basis by a workers’ compensation administrative law judge if there is a dispute over your medical care in order to resolve the dispute. 



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