Utilization Review Communication
Sample Approval Letter Download a Requestfor Authorization Form Sample Denial Letter
When a treating physician submits a request for medical treatment, the insurance company will, more often than not, submit that request to a Utilization Review (UR) company. That company assigns a physician to review the request and either approve or deny the treatment.
The Utilization Review Timeline
In most circumstances, the Utilization Review company must respond within five days of receiving the medical treatment request. The injured worker will receive a copy of a letter from the UR company detailing its determination — approving, denying, delaying, or modifying the requested treatment.
If Your Treatment Is Denied
A UR denial is not necessarily the end of the road. If treatment is denied, delayed, or modified, the injured worker can appeal that decision through Independent Medical Review (IMR), which must be requested within 30 days of the denial.
How GEKLAW Can Help
Utilization Review denials are common, and the appeal deadlines are strict. An experienced Workers' Compensation attorney can help you respond quickly, gather the medical evidence needed, and pursue the treatment you need. If your treatment has been denied, we can help.
