The Impact of California Workers’ Compensation Utilization Review Delays on Injured Workers

Workers’ compensation is a state-regulated system that provides benefits to employees who are injured or become ill as a result of their job. The system is designed to cover medical expenses, replace a portion of lost wages, and other costs associated with the injury or illness. However, the claims process can be complex and time-consuming, especially when it comes to utilization review (UR).

Introduction to workers’ compensation utilization review delays

UR is a process that is used to review medical treatment requests of treating physicians to confirm they are medically necessary and appropriate. In California, the Division of Workers’ Compensation (DWC) requires all medical treatment requests undergo UR. UR is intended to control costs and ensure that injured workers receive appropriate medical care. However, UR delays can have significant impacts on both employers and employees.

The impact of UR delays on employers

UR delays can have significant impacts on employers. Delayed medical treatment can result in longer recovery times and increased workers’ compensation costs. When employees are unable to return to work, employers may have to hire temporary replacements or adjust work schedules to accommodate the injured worker’s absence. This can result in lost productivity and increased labor costs.

UR delays can also lead to increased litigation costs. When employees legitimate treatment is being delayed unnecessarily, they are often forced to hire an attorney to assure prompt treatment is provided. These unnecessary frictional costs are passed on to the employers, and can result in increased workers’ compensation premiums.

The impact of UR delays on employees

UR delays can have significant impacts on employees as well. Delayed medical treatment can result in longer recovery times, increased pain and suffering, and decreased quality of life. In some cases, delayed medical treatment can result increased permanent disability.

UR delays can also lead to financial hardships for injured workers. When employees are unable to work due to their injuries, they may not receive a regular paycheck. This can result in financial stress and difficulty paying bills.

The cost of UR delays on taxpayers

When treatment is unnecessarily delayed by UR, this usually results in increased administrative costs for the workers compensation system because administrative resources are required to resolve the issues. Some injured workers are forced to obtain the benefits from Medicare or State medical programs like Healthy Families.

Strategies for dealing with UR delays

There are several strategies that employers and employees can use to deal with UR delays. One strategy is to work with an experienced workers’ compensation attorney. An attorney can help navigate the complex UR process and ensure that injured workers receive the medical treatment they need.

Employers can also take steps to prevent UR delays. This includes working with their workers’ compensation carrier to ensure that all medical treatment requests are submitted correctly and promptly so that the injured worker receives the treatment they need so they can get back to work.

Legal options for employers and employees

If UR delays result in financial or other hardships for employers or employees, there may be legal options available. Employers and employees can file complaints with the DWC or file lawsuits against workers’ compensation carriers or employers for bad faith handling of their employee’s claim.

An experienced workers’ compensation attorney can provide guidance on the best legal options for the injured worker so they can finally get the care they deserve.

Don’t wait any longer

If you need help navigating the workers’ compensation system and are facing UR delays, contact Tom Martin at 714-547-5025. He has been securing the benefits his clients deserve for over 30 years.