Utilization Review for Injured Airline Workers

Chicago Lawyers for Employees Hurt at Work

Utilization review is an insurer’s chance to examine a request for medical treatment. Utilization review for injured airline workers looks at whether there was workers’ compensation coverage for medical services. It allows the insurer to minimize its costs to decide whether a recommended treatment was proper. If you’re denied coverage or particular benefits in Chicago as an injured airline worker because of a utilization review, you can appeal. If you are in this situation, it is wise to consult an experienced Chicago workers compensation attorney who understands the particular needs of airline employees.

Utilization Review for Injured Airline Workers

Oftentimes injuries prevent airline workers from going back to work and being able to provide for their families. A skillful workers’ compensation attorney may be able to show that they are entitled to benefits under the Illinois workers’ compensation system. Among other things, the worker may need to show the medical services they have received for their injury were necessary, and any expenses were reasonable for purposes of treating the work-related injury. Under section 8.7 of the Illinois Workers’ Compensation Act (IWCA), an employer or insurer can challenge the medical services used by the airline worker through a utilization review and other methods.

Right to Utilization Review

In Illinois, employers may initiate a utilization review to evaluate whether the health care services being used by an injured airline worker are appropriate. Sometimes the utilization review is used for purposes of reducing medical expenses. It’s assumed that medical providers won’t violate limits identified in a fee schedule by increasing the frequency and type of treatment they are providing. Sometimes employers use utilization review to argue that a particular kind of medical care an airline worker is receiving is not necessary.

There are different types of utilization review. When a utilization review is current, it examines whether current ongoing treatment is appropriate. When a prospective review is used, it determines whether a future recommended treatment is proper. Either way, the program used by the employer to handle a utilization review is supposed to be registered with the Illinois Department of Insurance. Once the review takes place, medical treatment might be certified or it might be denied. If it’s certified the worker will go forward with the treatment. However, if it’s denied, the worker has the option of appealing the decision.

The utilization review provider must register every 2 years under section 8.7b of the IWCA. When a retrospective review is made, it is supposed to be based only on whatever medical information was available to the doctor or ordering health care provider at the time a decision about treatment was made.

What Happens During Utilization Review?

The reviewer handling the utilization review will decide what proper treatment is by reviewing only medical records. The reviewer doesn’t conduct a direct examination of an injured airline worker. Often the review isn’t even handled by someone local to you, but will instead take place far away. The reviewer’s opinion about whether to deny or grant your lab work, tests, or treatment will be restricted to the information the insurer provides the reviewer. It can be important to hire an experienced attorney if a utilization review has been ordered in your case.

Seasoned Chicago Attorneys for Workers’ Compensation Claims

Methods like utilization review for airline workers can permit workers’ compensation insurers and employers a means to deny medical treatment that a doctor, chosen by the worker, has recommended and prescribed. An experienced workers’ compensation lawyer can help you protect your rights and fight for the treatment you need during this process. The experienced legal team at Katz, Friedman, Eisenstein, Eagle, Johnson & Bareck handles claims for injured workers in Rockford, Quincy, Aurora, and Champaign, as well as Kane, Cook, Winnebago, Adams, and Sangamon Counties. Contact us at 800-444-1525 or at 312-263-6330 or by completing our online form.