2018 Workers Compensation Newsletter - Fourth Quarter

Under what circumstances do you recommend a Utilization Review (UR) or an Independent Medical Examination (IME) in an otherwise compensable claim?

 

In Wisconsin, a Utilization Review is a permissible but perhaps not an ideal tool to employ to challenge reasonableness and necessity of treatment in Wisconsin. Because in Wisconsin the process to challenge the necessity of treatment in a compensable claim begins upon receipt of a completed bill, and a medically supported denial must be provided within 60 days, a UR may be a useful cost containment tool given the quick turnaround required—but challenges to admissibility of the report may occur if the claim becomes litigated. An Independent Medical Examination is recommended when a disreputable provider is involved; when there are questions of extent of overtreatment; when there are suspicions about whether a patient is malingering; and to challenge a clearly excessive permanent partial disability rating. Please see memo here.