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Utilization Review

Workers’ Compensation Attorney Representing Spartanburg and Greenville Residents

One of the most stressful things that a person can experience is suffering an injury on the job. For many of us, our livelihoods are absolutely essential to ensuring that we can pay our bills and take care of our families. Fortunately, the workers’ compensation system is designed to provide benefits to people who are hurt in a job-related accident. This includes not only sudden events like slip and falls or car accidents but also conditions that manifest over a long period of time through repetitive actions such as assembly line work. Greenville and Spartanburg workers’ compensation lawyer Patrick E. Knie has substantial experience assisting injured South Carolina employees with navigating the process of pursuing benefits and is prepared to put his skills to use for you.

Understanding the Utilization Review Process

One of the most important aspects of the workers’ compensation system is referred to as utilization review. This process provides prospective, concurrent, and retrospective reviews of the medical necessity and appropriateness of the health care services offered to an injured employee. It also provides for the same types of review regarding experimental or investigational health care services.

If you are hurt on the job, you should not hesitate to seek prompt medical attention and notify your employer of your injury. In most cases, your employer will then submit a claim with its insurance carrier to assess whether you are entitled to benefits and, if so, the amount and extent of the payments that should be made. Injuries are assessed according to two metrics: whether they are partial or total, and whether they are temporary or permanent. Injuries that are partial and temporary will generally result in short-term payments, reflecting a percentage of the employee’s wages, whereas permanent and total injuries will yield higher payments over a longer period of time. In the latter instance, an injured worker may also qualify for Social Security Disability Insurance (SSDI).

The utilization review process is used to determine whether a particular treatment prescribed to the injured employee or requested by the employee falls within the scope of the benefits that the employee has been awarded. Also known as utilization management, this process can be used to approve both past medical treatments for reimbursement through benefit payments and to approve future payments for prospective treatments that the injured worker may need, such as medications, physical therapy, or surgery. In any review proceeding, the reviewer will first collect information about the injured worker’s symptoms, diagnoses, lab work, and required or requested services. The reviewer, who is a medical professional, will then determine whether the prescribed treatment matches the employee’s needs and issue an approval or denial of the request. As a result, it is critical to ensure that the reviewer has accurate and complete information in front of him or her when making a decision so that the employee’s needs are adequately represented.

Contact an Experienced Workers’ Compensation Lawyer in Greenville or Spartanburg

At the Knie & Shealy Law Offices, we take pride in treating each client who seeks our assistance with the personal attention, compassion, and dedication that they deserve. Serving people throughout Greenville, Cherokee, Union, Laurens, and Spartanburg Counties, Spartanburg and Greenville workers’ compensation attorney Patrick E. Knie provides a free consultation to help you learn more about the workers’ compensation system, the utilization review process, and the benefit payments that may be available to you. There is no need to navigate the workers’ compensation system on your own. Call us now at (864) 582-5118 or contact us online to set up an appointment with a workplace accident attorney.