Ask the Doctor? - Utilization Review in Delaware

21 October, 2009 12:31:00 LexisNexis Workers’ Compensation Law Center

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By Cassandra Roberts, Young Conaway Stargatt & Taylor LLP

Today I have the pleasure of hosting guest blogger Michael Owen, Esquire of the Wilmington insurance defense law firm of Chrissinger & Baumberger. Mike and his colleagues have been testing the waters in the wake of the newly-enacted Practice Guidelines and Utilization Review mechanism for challenging medical treatment expenses. He contacted me in reply to a call for information and insights on the perceived scope of the UR inquiry and offers the following:

"As you know, an employer or insurance carrier may engage in UR to evaluate the quality, reasonableness, and/or necessity of proposed or provided health care services for acknowledged compensable claims.

Subsequent to a party submitting its UR application, a UR company is randomly selected by the Department of Labor for review of the treatment to determine if it is in compliance with the practice guidelines developed by the Health Care Advisory Panel and adopted and implemented by the Department of Labor.

With regard to the IAB’s UR specific service FORTE, parties can depose (via telephone) the UR reviewing doctor regarding their opinion for a fee of $350.00 an hour. The contact for scheduling same is Dr. Adam Richardson at 1.800.580.4568 Ext. 28435.

I suspect the other UR companies used by the IAB will allow their doctors to be deposed; as I confirm this, I can let you know the names and contacts of same.

Should you have any questions or concerns, please feel free to contact me."

In the months to come I will be taking a close look at UR decisions for the scope of inquiry in terms of compliance with the Practice Guidelines and what else might be considered a hallmark of unreasonable treatment. I will also continue to report on the outcome of IAB appeals from UR rulings. In the meantime Mike can be reached for further discussion regarding the above at (302) 777-0100 or at Michael.Owen@LIbertyMutual.com.

A workers' comp law blog by Cassandra Roberts