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Utilization Review for UPS Drivers

Chicago Lawyers for Utilization Review for UPS Drivers

Working for UPS can be a strenuous job. It is not uncommon for UPS drivers to be seriously injured on the job. As a UPS driver, you may need to make a workers’ compensation claim after a work accident. However, the path to obtaining benefits you need as an injured UPS driver may not be smooth. UPS’ insurer is entitled to use a utilization review of your past, present or future medical care to figure out whether the degree of care and the quality of medical services is proper. If you are concerned about utilization review for UPS drivers, you should discuss the situation with the experienced Chicago workers’ compensation lawyer. Our firm has represented accident victims for more than 60 years.

Utilization Review for UPS Drivers

Under Section 8.7 of the Illinois Workers’ Compensation Act, utilization review can be ordered for a range of different medical procedures, including hospitalizations or office visits, in connection with your workers’ compensation claim. A utilization review will evaluate whether certain health care services are medically necessary, and the quality of services being given to you as a patient, including an evaluation of whether your treatment is efficacious, efficient or appropriate.

Our lawyers can make sure that the utilization review is conducted properly, and your rights are protected. UPS is required to use a utilization review program that the Illinois Department of Insurance has already registered. Medical treatment can be denied or certified. If your treatment is certified, treatment will proceed. However, if it’s denied, you can appeal the decision.

Often a utilization review is used to lower medical expenses. It assumes health care providers won’t violate fee schedule restrictions by increasing the number and kind of treatment. In other words, UPS and its insurer may argue that the medical treatment you’re receiving or for which your doctor requests authorization is unnecessary.

There are different sorts of utilization reviews that could apply to your situation. Utilization techniques may involve prospective review, concurrent review, second opinion, peer review, discharge planning, and retrospective review. Evaluation needs to be accomplished through the use of a system that identifies the utilization of health care services based on standards of care or nationally recognized peer review guidelines.

Whether treatment has already occurred will determine the kind of utilization review UPS’ workers’ compensation insurer will order. For instance, if you get into a crash while delivering a package, and you suffer complex fractures, a prospective review may be ordered to determine whether an especially expensive surgery is appropriate. However, utilization review cannot be used to prospectively review of necessary first aid or emergency treatment.

Current reviews may be ordered to look at ongoing treatment. For example, if you’re receiving ongoing chiropractic care, a utilization review will examine this treatment. Meanwhile, a retrospective review will look at medical information your treating doctor needed at the time of making a decision about what treatment would be appropriate. A utilization review may be ordered in addition to an independent medical exam (IME). Unlike an IME, there are restrictions on utilization reviews. Unlike an IME, the person conducting the review must decide what treatment is reasonable only through a medical records review. He or she will not examine you. Further, there may be no medical intake performed at all. Rather the reviewer’s opinion on whether to deny your treatment or tests will be restricted to information given by the insurer. Our attorneys may be able to help you surmount the hurdles placed by UPS’s insurer.

Third Party Lawsuit

Your medical records will also be reviewed if you bring a third-party personal injury lawsuit for damages arising out of injuries. However, you will not need to go through a utilization review. Instead, in most cases, a UPS collision that gives rise to personal injuries requires our seasoned attorneys to prove it’s more likely than not: (1) you were owed a duty to use reasonable care, (2) breach of the duty to use reasonable care, (3) causation, and (4) actual damages. Your medical records will need to be reviewed in connection with causation and damages in your case; we may need to retain a medical expert to provide opinions. UPS’s attorney will likely also retain a medical expert. Consult an Experienced Attorney for Injuries You Experienced as a UPS Driver.

Utilization review for UPS drivers can have significant consequences for your claim. 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.