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What are the insurance companies doing now? They are using "Utilization Review" in order to cut off workers compensation benefits. How does that work?

Well, the Alabama Workers Compensation Act allows for "Utilization Review". That means that the workers compensation insurance carrier can submit your medical records to a third party physician to review and determine if they are related to the injury. If that third party physician says, "No", the workers compensation carrier cuts off the injured employee’s benefits.

How does this work in practice? Take my client for example. She had surgery approximately ten (10) years ago. Her workers compensation case was settled, and her medical was left open for future treatment. Typically, that is what happens in workers compensation cases. The person receives medical treatment for the related injuries for the rest of her life.

For ten (10) years, my client has been receiving prescriptions and medical treatment for her injuries. Out of the blue, the insurance carrier sends her records to a foreign doctor in El Paso, Texas who opines that her injuries and medical treatment are not related. So, the insurance carrier, under the "utilization review" provision, cuts off her medical treatment.

Why did they wait ten (10) years? How can this doctor supersede my client’s local doctor’s opinion when he hasn’t even examined her. Shouldn’t the "Authorized treating" physician have the final say? The insurance carrier approved her "Authorized Treating" Physician.

This is ridiculous and unfair, but that is how the insurance industry works. Insurance covers everything but the loss. All they want is their money and to hell with everything else – morals, humanity, sympathy, kindness, and generosity. It is all about the bottom line. People talk about "greedy trial attorneys" when they should be talking about "greedy insurance companies".


  1. Gravatar for Tom Edwards

    Very true and sad. I have seenthis happen way too many times for it not to be an intentional practice in the insurance indusrty.

  2. Gravatar for Jon Lewis

    I agree. I am going to file something in this case. I don't know what, but something. This practice has got to stop. It is a total abuse of the system. They talk about frivolous lawsuits. What about this frivolous action?

  3. Gravatar for Doug Landau

    They do this in Virginia also. Does Alabama have "Bad Faith Claims handling" laws such that your client could sue the insurance company ? Florida has laws that allow for lawsuits to be successfully brought against the workers compensation insurance company. Unfortunately, Virginia has almost no "bad faith" insurance law, so the comp carriers get away with all sorts of nefarious activities. Keep up the good fight.

  4. Gravatar for dedie miller

    I know what u mean!!!!!!!! Its crazy i was injuried on the job 3/06 and was not given the proper medical attention. I have been disabled since 3/06 actually since then I lost my job in 12/06 i was not hired by a new company that took Goodyear Tire and Rubber company over or lets say they didn't hire me because of several surgeries and then a 30 pound package fell 8 feet off a modual and hit me in the side of the head and my associate who was working with me seen the whole thing. I made a accident report and went to the E.R. i was sent home that night after being given pain meds and was told too wait and be seen by workers/comp doctors the next avaiable day. I was seen and told of course it was a pulled muscle and never forget that the dr. told me that I probably had TMJ. now this is a medical dr. take it that there hasn't been the first x-ray or even check me with hands on and gives me pain meds and light duty till he sees me back n 2 weeks! Return and still bothering me sends me to T.O.C IN Huntsille al. Then fight begins had 2 dr.'s wanting to do surgies.then the famous workers/comp wanted to change doctors. I beleive that when you are hurt on the job and you do what your suppose to do that there should be laws put into affect to protect the injuried,NOT THE INSURANCE COMPAINES!!! Its a racket. Then I was let go in 12/06 and have not been able to work since. After 2 years of fitting with Goodyear i finally got on SSiD which is nothing to what my pay was. My average weekly earnings where $1047. done of my pay was made up neither did I get ttd only thing i got was a lost job 12/06 and lost almost everyhing in the process. Yea there needs to be better laws in ALABAMA,ones that protect the workers not the insurance compainies and the employer. All my medicals where left open and still can't get a thing done!! Any adviced i was told that in December that they gave me $3000.00 for just the fact of being hit in the head,now once again i'm getting run around. DOES IT EVER END!!!!!!

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