This video reviews the benefits to filing an appeal of a utilization review denial. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
When a treating doctor issues a Request for Authorization (RFA), it generally goes to utilization review (UR). The adjuster can authorize the treatment without going through UR. However, if the treatment is to be denied or modified, then it must go through UR. If there is a denial or modification, the injured worker has the option to appeal that denial through the Independent Medical Review (IMR) process. That appeal goes to Maximus, the company that does the IMR, and a new doctor will look at the request and denial.
Jeremy Lusk is a certified specialist in workers’ compensation with almost two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at questions@mywcguide.com
