Utilization Review for FedEx Drivers

Chicago Workers’ Compensation Lawyers for Utilization Reviews

As a FedEx driver, you can file a workers’ compensation claim for benefits, if you are injured on the job. While the workers’ compensation system was meant to be easier for laypeople to navigate than the civil court system is, it is still fairly challenging. FedEx’s insurer may want to apply a utilization review of the medical care you receive as a benefit to determine whether the quality of treatment you’re receiving or have received is appropriate to your situation. If you are worried about a utilization review as a FedEx driver, you should call our experienced Chicago workers’ compensation lawyers. Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca has represented accident victims for more than 60 years.

Attorneys to Protect FedEx Drivers’ Rights in Utilization Reviews

Section 8.7 authorizes FedEx’s insurer to secure a utilization review for medical office visits, hospitalizations, and other treatment related to your workers’ compensation claim. The purpose of such a review is to decide whether the services you’re receiving our medically needed and whether your treatment is appropriate and efficient.

We can ensure that your utilization review is performed appropriately with an eye towards protecting your rights. FedEx must use a utilization review program that has already been registered with medical treatment being certified or denied. When treatment is certified it will go forward, but if it is denied you may appeal.

Utilization reviews are used to reduce the medical expenses that the insurer pays. You are entitled to reasonable and necessary medical care for work injuries as part of your workers’ compensation benefits. However, FedEx can use a utilization review to show that you’re receiving unreasonable or unnecessary care as a medical benefit.

Types of Utilization Review

Generally, utilization reviews are performed according to specified care standards or application of guidelines by peers that are recognized around the country as appropriate ones. The nature of the treatment that’s being reviewed will dictate the type of review that is proper. A utilization review may involve evaluation of prior medical care, review that is concurrent with ongoing treatment, a second opinion, or a retrospective review. It may be used in connection with discharge planning if you’ve been hospitalized.

Utilization review is inappropriate for emergency care after you suffer your injuries or in connection with those injuries. However, it could be used if, for instance, you suffered crushing injuries in a FedEx truck accident and your treating physician believed that an amputation surgery is the right course of action.

In addition to a utilization review, the insurer may order an independent medical exam (IME). These are performed by a doctor hired by the insurer; in most cases, that doctor is known to be conservative in care recommendations. The report created by the IME doctor may be used as evidence alongside a utilization review to support an insurer’s claim that you are not entitled to a particular type of medical care or that it shouldn’t have to reimburse your physician for care because that care wasn’t necessary.

Utilization reviews are different from IMEs partly because the reviewer will determine the reasonableness of the medical care through a review of records provided by the insurer, not by asking you questions or examining you. An IME doctor performs a physical exam that is either general or directed towards answering questions posed by the insurer about what care is appropriate under the circumstances.

Consult a Seasoned Chicago Workers’ Compensation Attorney About a Utilization Review

As a FedEx driver who is injured on the job, you may need immediate medical care, and it is wise to seek it out right away and provide notice to your employer. Unfortunately, many valid claims are unfairly denied. It is crucial to seek legal counsel if it appears FedEx insurer disputes the medical care that you need. We represent injured FedEx drivers in Aurora, Champaign, Rockford, Quincy, as well as Sangamon, Winnebago, Kane, Cook, and Adams Counties. Our Chicago attorneys also handle third party lawsuits and Social Security Disability Insurance (SSDI) claims. Call us at 312-724-5846 or complete our online form.