Utilization Review for Amazon Flex Drivers
Work-related injuries can impact your ability to provide for your family, stop you from returning to work, and cause immense pain. As an Amazon Flex driver, you may assume that you are an independent contractor who is unable to recover benefits. However, there is a presumption that you are an employee in Illinois, unless Amazon Flex can prove you are an independent contractor by establishing certain conditions at a relevant proceeding, such as a workers’ compensation hearing. Our experienced workers’ compensation attorneys can help establish your entitlement to medical expenses and other benefits. Even so, Amazon Flex can challenge whether your medical expenses were reasonable and necessary by ordering a utilization review. If you are concerned about utilization review for Amazon Flex drivers, you should discuss your situation with the experienced Chicago workers’ compensation lawyers of Katz, Friedman, Eisenstein, Johnson, Bareck and Bertuca.Utilization Review for Amazon Flex Drivers
Your employer or its workers’ compensation insurer may challenge the medical services to which you’re entitled by pursuing a Utilization Review under section 8.7 of the Illinois Workers’ Compensation Act. A utilization review looks at the necessity, reasonableness, and frequency of your medical treatment. Under Section 8.7, a utilization review is the evaluation of proposed health care services to decide the propriety of the health care services that are medically needed and the quality of health care services given to a patient. Issues that may be determined in a utilization review include evaluation of efficiency, efficacy, and appropriateness of office visits, hospitalizations, and treatment. An independent medical exam (IME) doctor may be able to comment on the same issues, but utilization reviews involve a different process and evaluating entity. They also have different ramifications. Utilization reviews create a rebuttable presumption the insurer isn’t responsible for penalties due to delay. The utilization review is only valid if it is conducted using a system that specifies the utilization of health care services according to standards of care or peer review guidelines recognized at a nation level.
Utilization techniques can include prospective review or getting a second opinion. They can also include peer review, discharge planning, and concurrent review.Lawyers to Defeat Rebuttable Presumption Associated with Utilization Review
If your employer’s denial of medical services is in line with an approved utilization review program, there may be a rebuttable presumption your employer won’t need to pay additional compensation. This is why it is crucial to retain Chicago attorneys in connection with your workers’ compensation claim as an Amazon Flex driver. When Amazon Flex’s insurance provider denies or refuses to authorize and it doesn’t comply with a utilization review program and doesn’t follow other requirements, the Illinois Workers’ Compensation Commission will consider this as evidence in deciding whether Amazon Flex should be responsible for paying under section 19(k).
Section 19(k) specifies that if there is vexatious delay of payment or intentional underpayment of compensation, which are instituted or carried out by someone liable to pay compensation and they are merely frivolous, the Illinois Workers’ Compensation Commission can award compensation beyond what’s payable under the Act. It can be equal to 50% of what’s payable at the time of the award.
Prospective treatment that could be subject to a utilization review could include any of the following:
- Determining whether a hospital admission is proper.
- Determining whether expensive/invasive treatments such as repeat surgeries or hip or disc replacements are reasonable and necessary.
- Expensive laboratory tests or imaging to diagnose the injury.
- Determining whether it is reasonable and necessary for you to seek physical therapy, chiropractic, or occupational therapy.
- Pain treatment and management.
- Figuring out whether a particular place for medical treatment is proper.
Our experienced Chicago attorneys may be able to evaluate whether utilization review is appropriate in your case. Utilization review for Amazon Flex drivers may be only one of several hurdles to be surmounted and it’s important to have a legal team by your side. We have represented accident victims for more than sixty years. We also represent injured workers in Champaign, Rockford, Quincy, and Aurora, as well as Sangamon, Winnebago, Kane, Cook, and Adams Counties. Call us at 800-444-1525 or 312-263-6330 or complete our online form.