What Is Utilization Review?

Workers compensation benefits pay injured weekly benefits while they are out of work. These benefits also pay for medical bills stemming from the industrial accident.  In order for workers compensation medical bills to be paid, utilization review is the process that must be followed.


what is utilization review?

Utilization review is followed by all workers comp insurance companies in Massachusetts.  It is a process in which medical providers seek approval for a given medical procedure to be administered to an injured worker.

The medical provider must strictly follow the rules and procedures for utilization review in order for the treatment to be considered. Failure to do so will result in the issuance of a denial by utilization review.

This is a tightly regulated and comprehensive review to see if the proposed treatment is reasonable, necessary and related to the accident.

If a procedure is denied by utilization review, the medical provider may appeal that denial.  If the appeal is also denied, then a claim can be filed at the Department of Industrial Accidents to get a judge to order an insurer to pay for the requested medical treatment.

The appeal must be accompanied by a note from a doctor that supports the necessity of the requested treatment, as well as the actual denial letter issued by utilization review.

Contact the Law Office of Christopher Earley if you need help with any type of work injury issue in Massachusetts.