New Study Shows Majority of Workers’ Comp Medical Reviews Agree with the Treating Physician

Posted on : October 21, 2017
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One of the most common challenges faced by injured workers is that after they get conflicting information from the employer-required doctor and their own physician. This is a big reason to get a second opinion to begin with, because plenty of workers hurt on the job believe that the doctor requested by the employer did not give a fair assessment. No matter who you see after a workplace injury, it should be someone you can trust. Giving them all the necessary information upfront helps you to figure out the depth of your injuries and what you should do next.

More than 91% of utilization review physician modification or denials of treatments were evaluated by independent medical doctors or upheld in a recent California study. The independent medical review process was established in California to resolve some of the most common medical disputes associated with workers’ comp claims. According to the study, the majority of treatment requests are approved by the utilization review but in 2012, legislators adopted independent medical reviews to give injured employees a chance to have an independent medical opinion on treatment requests that any utilization review doctor modified or denied.

 

More than 86,000 independent medical review decision letters were analyzed in the first half of 2017 and were submitted to the state after a utilization review doctor denied or modified a medical service request. Independent medical review physicians tended to uphold the utilization review doctors’ modification or denial service the majority of the time. However, if you attend a doctor on behalf of employer’s request sustaining an injury on the job and your own physician does not agree with the treatment recommendations or the diagnosis you have received, it is strongly recommended that you consult with an experienced workers’ compensation attorney to help protect your legal right to pursue compensation through the state. Having an attorney at your side can assist you when you experience delays or denials in the process and can ultimately protect the compensation you need to recover it in full.