Utilization Review (UR) Complaint Form {DWC UR 1}

UTILIZATION REVIEW (UR) COMPLAINT FORM. In California, all employers or insurance companies handling workers’ compensation claims are required to have a utilization review (UR) program. A UR program allows an employer or insurance company to review a treatment request made by an injured worker’s physician to determine if the treatment is medically necessary. Following this review, the treatment request can be approved, denied, or modified. The UR process is governed by Labor Code section 4610 and implemented through regulations beginning at California Code of Regulations, title 8, section 9792.6. Medical providers, injured workers or others who find that UR has not been performed as it is required by statute or regulations can file a complaint with the DWC. The attached form may be used to register a complaint regarding UR services connected with workers’ compensation injuries and treatment. All valid complaints will be used to assist DWC during our utilization review organizations (URO) investigations in oversight of the UR organizations and programs. www.FormsWorkflow.com