We have previously reported on the myriad ways in which workers’ compensation carriers’ procedures add costs to the system and thereby drive up insurance rates. Here is yet another example.
We represent an injured worker who is receiving medical treatment for her injuries. In the course of her case, she has been evaluated by an Agreed Medical Evaluator (an AME is a doctor selected by both the injured worker and the workers’ compensation carrier). The AME recommended she undergo various treatments. The W.C. carrier then authorized that treatment and Applicant completed same.
Even though it approved the treatment, the carrier sent the treatment request to a process called Utilization Review to assess the propriety of the requested treatment. This review costs money and adds to the system cost. So, here, a carrier unnecessarily spent money on reviewing the propriety of the treatment which it had already approved and which the injured worker has already received. This is not an isolated incident and reflects the lack of attention to treatment issues and the wastefulness within the system.