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Utilization Review

EMPLOYERS strives to assist healthcare professionals in providing the medical treatment most appropriate for an injured employee. Authorization requests are reviewed to confirm treatment is in accordance with nationally-accepted clinical guideline standards.

Our Medical Director and Utilization Review Physicians work in collaboration with our healthcare professionals during the Utilization Review process. Physicians may review and certify, or non-certify, services requested by an injured employee’s treating physician. If a treatment requested is not appropriate for the industrial injury, it may be non-certified. Physician Advisors provide medical necessity decisions based upon nationally-accepted clinical guideline standards.

In addition to consultation regarding medical treatment issues, our Medical Director and Physician Advisors can review claims compensability when necessary.