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Utilization Review for Amazon Workers

Chicago Lawyers for Injured Amazon Workers Faced with Utilization Review

Amazon is often touted as a place full of opportunities for its workers. Unfortunately, the speed at which workers must act in the workplace and the repetitive motions can result in serious job-related injuries. As in other workplaces, Amazon workers are at risk of acute injuries in a range of circumstances. After bringing a workers’ compensation claim, Amazon’s insurer may perform what’s called a utilization review of your past, current, or prospective medical care. If you have concerns about utilization review as an Amazon worker with a workers’ compensation claim, you may need legal representation. The experienced Chicago workers’ compensation lawyers of Katz, Friedman, Eisenstein, Johnson, Bareck and Bertuca may be able to represent you and counsel you through the potentially challenging claims process. We have more than 60 years of experience representing accident victims. You should call us.

Utilization Review for Amazon Workers

Under Section 8.7 of the Illinois Workers’ Compensation Act, Amazon’s insurer can order a utilization review to determine whether the level of health care services you’re receiving or have received are appropriate. Utilization reviews also evaluate whether treatment, hospitalization or office visits are appropriate based on medically accepted standards. The valuation needs to be accomplished through a system that identifies the utilization of health care services based on either peer review guidelines that are nationally recognized or standards of care. Utilization reviews can be prospective, concurrent, or retrospective. Utilization review is not supposed to be used for purposes of prospective review of emergency treatment or first aid. For example, if you suffered a partial amputation while working in the Amazon warehouse, you should be able to seek emergency care without regard to a utilization review. There are many different circumstances that might call for a utilization review. However, in some cases, these are ordered for the purpose of denying or reducing medical treatment. You may be able to overcome any efforts by Amazon’s insurer to deny or reduce medical treatment by hiring a knowledgeable attorney. Utilization reviews are supposed to be based only on medical information available to an attending doctor or ordering health care provider at the time of providing or ordering health care services. Section 8.7(i) provides that the Illinois Workers’ Compensation Commission will consider the utilization review along with other evidence and in the same way as other evidence in deciding whether medical bills are reasonable or necessary. None of the following should be reduced because an insurer orders a review:

  • You right to reasonable and necessary medical treatment
  • Your choice of health care provider under section 8(a)
  • Amazon’s right to medical exams.

When Amazon’s denial of medical services complies with an appropriate utilization review program, there will be a rebuttable presumption Amazon won’t be responsible for paying additional compensation under section 19(k). When Amazon’s denial or refusal to authorize doesn’t comply with a utilization review program and doesn’t comply with other requirements, the Commission can consider this evidence, alongside other evidence. It should be considered the same way as other evidence in deciding whether an employer can be held responsible for paying additional compensation under section 19(k) of the Illinois Workers’ Compensation Act. Section 19(k) provides for penalties for delayed payment of benefits.

Third Party Lawsuit

Workers’ compensation benefits may not provide as much relief as damages in a third-party lawsuit. If you were injured through the fault of someone other than your employer or a coworker, such as another driver with whom you shared the road while traveling for work, you may be able to recover damages by bringing a third-party lawsuit against the responsible party. You’ll need to establish the following: (1) the defendant owed you a duty to use reasonable care, (2) departure from the duty to use reasonable care, (3) causation, and (4) actual damages. In cases involving complex injuries or future losses, our personal injury lawyers may need to retain an expert to review medical records and other records to estimate the total losses you are likely to experience as the result of disabling job-related injuries.

Consult an Experienced Attorney for Injuries You Experienced as an Amazon Worker

As an Amazon worker you face numerous stressors and dangers. You may suffer anything from minor chronic injuries to acute, catastrophic injuries as a result of your work. We 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.