Utilization Review for Injured City of Chicago Workers

Workers’ Compensation Lawyers for Chicago Employees

If you have been hurt on the job working for the City of Chicago, you may not be able to go back to work, and your income may be affected for a long period of time. Like big businesses, the City of Chicago is self-insured for workers’ compensation. In order to obtain medical benefits, you may need to show the City that your medical services are necessary and that you had reasonable expenses for treating or relieving your work injury. An employer or insurer can challenge your request for medical services through a utilization review. A knowledgeable Chicago workers’ compensation attorney can answer your questions regarding obtaining and keeping benefits after a work injury.

Utilization Review for Injured City of Chicago Workers

Section 8.7 of the Illinois Workers’ Compensation Act provides for a utilization review. The City of Chicago, like other employers, is entitled to conduct a utilization review of an employee’s medical care to determine whether the degree and quality of the services they are receiving is proper. The utilization review will look at whether hospitalizations and/or office visits are appropriate. Standards are based on what is medically accepted; utilization review serves to evaluate how effective and efficient office visits, hospitalizations and treatment are in light of these norms.

To make this evaluation, the City of Chicago uses a system that relies on standards of care as set forth in nationally recognized treatment and peer review guidelines. Utilization review programs need to be registered every two years with the Department of Insurance. The registration needs to certify compliance with the Workers’ Compensation Utilization Management Standards of the Utilization Review Accreditation Commission (URAC) or submit other evidence of URAC accreditation. Techniques for utilization review can include second opinions, concurrent review, peer review, discharge planning, independent medical examinations, prospective review, and retrospective review.

Different kinds of utilization review may be used for current, past, or proposed future care. A current review will look at your ongoing treatment. A prospective utilization review may be used to determine whether a recommended future treatment is proper. A retrospective review will evaluate a past decision based on the medical information a treating doctor had at the time any treatment decisions were made. The review involves your medical records, but you won’t need to undergo a physical exam for purposes of determining whether the treatment is proper. The reviewer decides whether to go forward with treatment or order tests based on information provided as part of the utilization review process.

Through utilization review, medical treatment for an injured City of Chicago worker can be certified or denied. When it is certified, you can go forward with your treatment. If your treatment is denied in this process, you will be able to appeal, and a skilled workers’ compensation attorney can help.

Scope of Review

Once the utilization review process is invoked and written notice is received, medical providers are supposed to submit to the utilization review. They are supposed to use reasonable efforts to give complete, timely reports of clinical information that is necessary support a request for treatment. When a healthcare provider doesn’t make reasonable efforts, the treatment or service charges may not be compensable or collectible. A medical provider’s reporting obligations are not supposed to be unreasonable.

Retain a Seasoned Workers’ Compensation Attorney in Chicago

If you have questions about utilization review for injured City of Chicago workers, you can call our firm. At Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca, our seasoned workers’ compensation lawyers can represent City of Chicago workers in areas including Champaign, Quincy, Aurora, and Rockford, and across Sangamon, Adams, Kane, Cook, Sangamon, and Winnebago Counties. We will look closely at your injuries to determine whether you’re also eligible for relief outside of the workers’ compensation system. Contact us via our online form or by calling 312-724-5846.