How does the new law on utilization review affect the process at the IWCC?
Section 8.7 provides that if an employer chooses to conduct utilization review, it must use individuals who are registered with the Illinois Department of Financial and Professional Regulation and who certify compliance with URAC standards for Workers’ Compensation Utilization Management (WCUM) or Health Utilization Management (HUM). Click here to read the IDFPR’s UR rules. At the IDFPR, Kelly Reim (217/558-2309) coordinates the processing of the UR applications. Click here for a list of approved UR providers. When making determinations concerning the reasonableness and necessity of medical bills or treatment, the IWCC will consider UR findings along with all other evidence. If an employer follows a WCUM or HUM URAC standard when refusing to pay for or authorize medical treatment, there shall be a rebuttable presumption that the employer should not be assessed penalties under Section 19(k).
