California workers’ compensation claims administrators who conduct utilization reviews got a 97% performance rating for 2013. Their goal from state insurance regulators was 85%, and they obviously succeeded and surpassed that goal.
Reviews for the past several years have been very high. These reviews are conducted on approximately 280 workers’ compensation claims administrators every year. The high score is based on timeliness in responding to treatment requests, which are generally completed with five working days. They also evaluate content for review determinations and delivery of written notices related to utilization review decisions.
The study eases the minds of those who feel that the state administrators have poor performance in meeting their obligations related to treatment requests. The overall review states that the process is “working effectively.”
Regardless of this glowing review, some claims administrators will be slower than others in processing treatment requests. If you or a loved one has had trouble getting your treatment request processed, then it may be time for an experienced worker’s compensation attorney to step in. Call Robbins, Strunk & Cramer at 408-848-1113 for more information.