The workers’ compensation system is designed to alleviate the financial pressure often caused by work-related injuries. But, before issuing benefits, you may have to submit to a utilization review, a process that determines whether the treatment you’re receiving is medically necessary. Receiving the benefits to which you’re entitled may depend on understanding this important step and how it can affect your claim.

What Is a Utilization Review?

During a utilization review, a group of claims adjusters, doctors, and other experts will look at your medical records and the treatment plan proposed by your physician. Their role is to decide whether the health care you receive is reasonable and necessary, based on medical standards. In Connecticut, utilization reviews are performed by the Worker’s Compensation insurance company.

When Do Utilization Reviews Occur?

In some states, every workers’ compensation claim automatically triggers a utilization review, while others leave it up to the discretion of the insurer. In most cases, the review takes place before specific treatment is or is not authorized. You can appeal the decision of the UR department, at a first level and if necessary at a second level..

What Happens if Your Treatment Is Denied?

Fortunately, your workers’ compensation claim won’t be automatically denied if the utilization review company decides your treatment isn’t medically necessary. In Connecticut, all claimants have the right to appeal, and may be able to take the case to a commission if their treatment is denied. This is especially true if the utilization review company’s decision is based on factors other than the medical care plan proposed by your doctor.

If you’ve sustained a work-related injury, the Law Office of Thomas L. Brayton III will guide you through the process and fight for your rights. This workers’ compensation attorney provides a level of service that has earned him the distinction of being an AVVO® top-rated 2019 lawyer. Visit his website to browse his services. Call (203) 591-8689 to reach his office in Waterbury or call (203) 266-7100 to schedule an appointment in his Bethlehem location.