You’ve filed a workers’ compensation claim, sought medical treatment, and now your employer or company insurance provider is questioning the physician’s recommended care. It’s a frustrating situation many employees face, and when it occurs we always encourage our clients to talk to a workers’ compensation attorney immediately.
When medical treatment has been provided and the bills come through to a company’s insurance carrier, sometimes the insurance provider or employer believes the treatment given was not reasonable or necessary. As a response, a utilization review request is made, which is a determination of whether medical treatment for a work injury was rational and needed. The review is done by an unbiased third-party, also known as a utilization review organization (URO). The third-party independent is typically a physician, surgeon or other health care provider, or sometimes a panel of these professionals. The URO reviews the medical information provided by the employee’s family and doctor and comes to a decision about whether the challenged treatment was reasonable and necessary for the work injury.
There is an opportunity for an employee to provide a personal statement to the URO about why the treatment should be justified, which can sometimes be a way to guide the reviewer to the right decision. Many do not know this is a vital option to use, which is why it’s important to work with a workers’ compensation lawyer to ensure this step can be done.
If the URO declares the suggested treatment was necessary, the medical provider get paid in full. If the employer or the insurance agency continues to deny treatment after the final ruling, then the employee must initiate a medical legal process to continue the trial.
Going through utilization reviews (URs) can be a trying time and it’s important an employee understands the full process and what he/she can do to fight for their case. The workers’ compensation attorneys at Prior, Criner & Edwards Attorneys understand the importance of getting the review approved, and will work with you every step of the way to ensure your medical treatment is reasonable and necessary. Contact our office today so we can get started on your case.
Call today for a free consultation and explore your options - (910) 341-3202
Our attorneys specialize in workman's comp, personal injury, and dispute resolution services.
Prior, Criner & Edwards Law, PLCC. have a long history of building long-term client relationships founded on trust and mutual respect.
With over 25 years of experience in civil litigation and thousands of cases mediated, Frank specializes in the fields of workers compensation and personal injury law.
Sherman is Licensed to Practice Law in North and South Carolina. He has extensive education in law and the mediation practice, professional experience and impressive memberships in many noteworthy political, civic and business organizations.
Ashley M. Edwards
Ashley is a NC attorney and certified mediator in North and South Carolina, Ashley has represented hundreds of clients and mediated thousands of cases for attorneys, insurance carriers and private companies.
“These guys are awesome and care about their clients very much. I would suggest anyone hurt on the job to contact them. Cannot express my appreciation enough to them!"
“Ashley Edwards genuinely cares about his clients and holds himself to the highest standards in all of his professional interactions. I am happy to recommend him to anyone who needs help navigating the workers compensation process."
“Ashley has been practicing compensation law in the greater Wilmington area for 15+ years. I have often turned to him for advice and counsel. He knows the law, is trustworthy, listens to his clients, and fights to do the right thing for them. He is my first call!"
“Mr Edwards made my case feel like it was his most important case. He is so caring and attentive."
“This was the first and only law firm I contacted after being injured. Everyone there has been on point concerning my case and extremely professional. I highly recommend contacting workers comp first if injured. It will be as if it's the most important case they have and they will not disappoint. Thank you to the entire team."
“Wonderful Experience under difficult circumstances. They helped me understand my rights and options under the law. Mr. Edwards took the time to help and meet with me whenever I had questions. He is highly recommended for his expert advice and service. "
“This is the place to go if you get hurt on the job Ashley and his paralegal Janet are really nice and super easy to talk to and they take the time to really listen to your problems and get you the help you need and deserve."
“They came out took out time to listen very smart he knows what he's talking about he heard me out and took my case under difficult sircumstances and i highly advise this is the law firm to consider."
“Sherman is one of the best mediators that I know---he is extremely proficient in Workers' Compensation Law and he is an outstanding communicator. I give Sherman my highest rating!"
“Great Experience with a caring lawyer who took the time to actually meet with me. He handled my case to the end and explained everything. Highly recommended."
“Ashley is very knowledgeable and relatable to his clients, to opposing counsel, and to all parties when acting as mediator. "
“Ashley didn't always tell me what I wanted to hear but he always told me the truth. He is very knowledgeable and professional... I would highly recommend Ashley if you feel the need to hire an attorney. "
Get in touch with our team for a free consultation.
Call (910) 341-3202 or complete the form on this page and we'll follow-up with you as soon as possible.