Complaint Form Issued for Employers, Insurers that Delay Medical Treatment
After hearing many complaints about inappropriate delays and denials of medical treatment, the state Division of Workers' Compensation (DWC) recently introduced a Utilization Review (UR) complaint form. This form can be submitted by mail or e-mail. Click here for a copy.
The law requires all employers and insurance companies that handle Workers' Comp claims to use a UR program to decide whether to approve requests for medical treatment. Physicians, injured workers and others can file a complaint if they believe a UR program isn't being run by the rules. Complaints may trigger a DWC investigation.
The DWC is also considering regulations to assess fines against employers and insurers that use the UR process to delay or deny medical treatment. Continue checking www.geklaw.com for updates on these regulations if and when they come into effect.
More on Medical Treatment and QME Disputes
- Comp Claimants With Attorneys Can Choose New Medical Panels
- Controlling Your Medical Treatment: Is Pre-designation the Right Option for You?
- Legal Challenges Are Made To The Medical Treatment Dispute Resolution Process
- Complaint Form Issued for Employers, Insurers that Delay Medical Treatment
- Court Clarifies Procedure for Spinal Surgery Disputes in Workers' Compensation Cases
- Examining the Role of a Nurse Case Manager in a Workers' Compensation Case
- Utilization Review: What Public Safety Officers Need to Know
Your options when treatment is delayed or denied
Every request for treatment from your doctor goes through the insurer’s utilization review (UR). For a routine request, UR generally has to decide within five business days of receiving the request, and never later than 14 days. Urgent requests must be decided within 72 hours. If UR denies or modifies the request, you can ask for independent medical review (IMR), usually within 30 days of receiving the decision. A UR decision that is late or procedurally defective can be challenged before a workers’ compensation judge.
These deadlines are short and easy to miss. See our guides to utilization review and independent medical review, and the IMR application form.
