What is the role of utilization review in workers' compensation?

Utilization review plays a critical role in the workers' compensation system by focusing on the necessity and appropriateness of medical treatments provided to injured workers. The primary aim of this process is to ensure that the medical care being delivered is not only appropriate for the injury but also cost-effective.

Through utilization review, medical decisions are evaluated to confirm that the treatments align with established guidelines and standards of care. This includes analyzing the treatment plan proposed by healthcare providers to ensure that it addresses the specific needs of the injured worker and is likely to facilitate recovery efficiently.

By promoting effective and appropriate medical care, utilization review helps control healthcare costs associated with workers' compensation claims and ensures that employees receive the medical attention they require for their recovery. This focus on the quality and necessity of care directly supports the overall objectives of the workers' compensation system.