What is a Utilization Review for Workers’ Compensation in North Carolina?

June 16 , 2017

Every year, thousands of workers are injured at their workplace. Injured workers often look for compensation in the form of insurance coverage provided by their employers. This is known as the workers’ compensation system. For some workplace injury victims, the whole process can run smoothly and without major consequences. However, others may not run with the same luck. Some injured employees can find their medical care has been denied after going through a utilization review. Our Charlotte Workers’ Compensation lawyers from Ramsay Law Firm discuss more of the utilization review and what can you do if your medical care or service is denied.

What is the Utilization Review?

Generally, every employer with three employees is required to provide workers’ compensation insurance to their employees. The purpose of the workman’s comp program is to provide coverage for injuries sustained in the workplace such as head injuriesback injuriesknee injuries, and broken bones.

Many insurance companies have a utilization review (UR) process. The stated purpose of a UR is to determine the appropriateness, viability, and effectiveness of proposed medical treatment for an injured worker.

In many instances, the workers’ compensation adjuster can approve treatment of an injured worker without using UR. Physical therapy and testing such as MRI are commonly approved without the use of UR. More expensive or invasive procedures such as epidural steroid injections, surgeries (arthroscopic or open), and nerve block injections often are subject to UR. However, an insurance company may run the recommendations through UR to determine if they want to oppose the treatment. If the insurance company refuses care, the injured worker can ask the Industrial Commission to approve treatment. This could be resolved by a written motion but may require a hearing in front of the judge.

Charlotte, North Carolina Worker’s Compensation Lawyers Offering Free Consultations

If you or a loved one was injured in the workplace, we can help you obtain the compensation you deserve. At Ramsay Law Firm, we understand how confusing and overwhelming recovering from a workplace injury can be. However, this should not mean there is no possibility of recovery. Let our decades of experience, knowledge, and skill work for you while you focus on recovering from your injuries. To learn more about your case in a free, confidential consultation, call our Charlotte personal injury lawyers today at (704) 376-1616 or contact us online.

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