How does utilization review reach a determination regarding the authorization of medical treatment?
Labor Code Sections 4604.5 and 5307.27 state that on or before December 1, 2004, a medical treatment utilization schedule is to be adopted by the State of California. This schedule will incorporate evidence-based, peer-reviewed, nationally recognized standards of care and will address the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers compensation cases. Once this schedule is adopted, it will be presumed to be correct on the issue of extent and scope of medical treatment. This presumption is rebuttable and may be controverted by a preponderance of the evidence establishing that a variance from the guidelines is reasonably required to cure and relieve the employee from the effects of his or her injury. Pursuant to Labor Code Section 4604.5, in the time period between now and when the medical treatment utilization schedule is adopted, the recommended guidelines set forth in the American College of Occupational
