What if you disagree with the utilization review (UR) determination for your workers' compensation claim? As of July 1, 2013, medical treatment disputes for all dates of injury are resolved by physicians through an efficient process known as Independent Medical Review (IMR). If utilization review denies, delays or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, the injured employee can ask for a review of that decision through IMR. The assigned physician reviewer will review relevant medical records and apply recognized treatment guidelines to determine if the requested medical treatment is appropriate for [...]
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Employer's in the State of California must abide by certain regulations administered by the Division of Workers' Compensation (DWC) when an employee suffers a work-related injury or illness. Elite Claims Management is ready to assist your company and work with your supervisors to make sure you are prepared if an incident happens. Here are a few things to keep in mind: Within 24 hours of notice of claim, provide injured employee with the Workers’ Compensation Claim Form – DWC-1 Within 5 days of knowledge of injury, complete the Employer’s Report of Occupational Injury and Illness DLSR-5020 form and send to carrier [...]