Utilization Review Communication

When a treating physician submits a request for medical treatment, the insurance company more often than not, will submit the medical treatment request to a Utilization Review company. This company will assign a physician to review and either accept or deny the medical treatment request.

In most circumstances, the Utilization Review company must respond within five days of receipt of the medical treatment request. An injured worker will receive a copy of a letter from the Utilization Review company detailing their determination. Click here for a sample of Utilization Review denial letter.

It is recommended that an injured worker verify that the physician, and if represented, their attorney, have received a copy of all Utilization Review letters. If there is a denial of medical treatment, an appeal of the denial must be filed within 30 days. Utilization Review is detailed in Labor Code Section 4610.