I Heard My Workers’ Comp Claim Is “Under Review.” What Now?

Being injured at work can be distressing. Dealing with your employer’s insurance company and seeing multiple medical providers only increases the stress. Just when you think your workers’ compensation benefits are safe, you learn that your workers’ comp claim is “under review.” What does this mean and how will being “under review” affect your benefits?

A Review of Your Medical Condition

Illinois workers’ comp law requires that employers buy insurance that covers work-related injuries. Sometimes employers or their insurance companies disagree with an employee’s medical treatments. Your employer may not be allowed to refuse to pay your medical bills unless a utilization review backs up the claim that your medical treatment was unnecessary or unreasonable.

If you hear that your case is “under review,” it probably means that a “utilization review” is being conducted. What this means is that someone who runs a utilization review program will be reviewing your medical records. Specifically, the review will be done to make sure that your past, current, and future medical treatments are necessary and are related to your work-related injury. Employers may ask for a utilization review to make certain medical treatments are not excessive or unreasonable.

There are three general types of utilization reviews:

  • Prospective Utilization Review (future medical treatments)
  • Concurrent Utilization Review (current medical treatments)
  • Retrospective Utilization Review (past medical treatments)

The Illinois Workers’ Compensation Act provides more detailed information about conducting these reviews.

What to Do About a Workers’ Claim That Is Under Review

Your options may be limited. During the utilization review, your doctors and other providers receive notice that your claim is under review. They may provide records, but also attend depositions and talk to the Illinois Workers’ Compensation Commission about your request.

An arbitrator assigned to your case should review the utilization review report and decide whether your benefits will be affected. If the arbitrator feels your medical treatment was not necessary or was not related to your on-the-job injury, your employer may not have to pay your medical expenses.

However, you and your attorney can review the report and the arbitrator’s decision. You may be able to file an appeal of the arbitrator’s decision. In some cases, you may be able to file a complaint about a Utilization Review Program that made a mistake or did not conduct the review as it should have.

If you don’t have legal representation yet, this is the time to hire an attorney with Illinois workers’ compensation experience.

Is Your Workers’ Comp Claim “Under Review?”

If so, you probably have questions about how the review will proceed and what, if any, you should do.

For assistance, talk with Osvaldo Rodriguez, an experienced Chicago workers’ compensation lawyer, for an honest assessment of your case. Schedule a free consultation by calling us today at 708-716-3441 or by completing the form on our Contact Us page.

We represent clients throughout the state of Illinois, including Chicago, Addison, Bellwood, Bensenville, Berwyn, Chicago, Cicero, Elmwood Park, Franklin Park, Maywood, Melrose Park, Northlake and Cook, DuPage, Will, and Kane Counties. Se Habla Espanol.

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