Utilization Review is defined in which Labor Code section?

Utilization Review is defined in which Labor Code section?

• A. 4610
• B. 4850
• C. 9900
• D. 139.5

Answer: (A)

Utilization review in California workers’ compensation is the process of evaluating medical treatment requests to determine whether care is medically necessary, appropriate, and consistent with established guidelines before or during treatment. This framework is defined in Labor Code section 4610, which authorizes the employer or its insurer to conduct UR through qualified reviewers and sets rules for notice, decision timelines, and dispute handling (including independent medical review when needed). This mechanism helps ensure injured workers receive appropriate care while controlling unnecessary or excessive treatments. The other listed Labor Code sections cover different aspects of the workers’ compensation system and do not define utilization review.

Utilization review in California workers’ compensation is the process of evaluating medical treatment requests to determine whether care is medically necessary, appropriate, and consistent with established guidelines before or during treatment. This framework is defined in Labor Code section 4610, which authorizes the employer or its insurer to conduct UR through qualified reviewers and sets rules for notice, decision timelines, and dispute handling (including independent medical review when needed). This mechanism helps ensure injured workers receive appropriate care while controlling unnecessary or excessive treatments. The other listed Labor Code sections cover different aspects of the workers’ compensation system and do not define utilization review.