Utilization review is a procedure by which the insurance carrier, self-insured employer or the claimant may request review of medical services rendered in a worker’s compensation case.  The purpose of such review is to find out if the medical care given was reasonable and necessary.  If the medical care is determined to be not reasonable or necessary, the utilization review panel may allow the insurance company or self-insured employer to deny payment of medical bills.  This procedure is also used by the insurance companies to try to force a change of physician.

This procedure is never used by claimants because the initial filing fee to request a utilization review is $1,250.00.  That is only a minimum fee, and the Director may notify a party who has started the utilization review of additional costs which may require a supplemental fee.  (Section 8-43-501, C.R.S.; Rule (D), Division of Workers’ Compensation Rules of Procedure).


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