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:
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:
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.