Utilization Review

State Fund's Utilization Review Program establishes a review of the treatment plan proposed for employees with a work-related injury or illness. Through the program, medical professionals approve, modify, delay, or deny treatment recommendations based on medical necessity. These health care professionals are California-licensed and include:

• Medical Doctors
• Doctors of Osteopathy
• Doctors of Chiropractic
• Registered Nurses
• Registered Physical Therapists

The Utilization Review Program is founded on the principle that appropriate medical care improves medical outcomes while containing costs. The objectives of the program are to:

• Reduce costs by eliminating unnecessary, inappropriate treatment.
• Deliver timely responses to physician requests for treatment authorizations.
• Reduce temporary disability costs by promoting Return to Work and use of transitional duty for the injured employee.
• Improve communication between the medical community and State Fund.

Effective medical management begins with the injured employee’s first visit for treatment of an injury. The Utilization Review Program helps establish an appropriate treatment plan to enable a faster recovery and return to work for the injured employee.