Denied by Design: Navigating the Access to Workers’ Compensation Care in Chicago Workers’ compensation (WC) was introduced as a no-fault system to provide injured workers with timely access to medical treatment and compensation for lost wages. When the treating physicians submit a care request to the third party insurer, these requests are often subjected to a utilization review process. Utilization Review (UR) is the process of comparing an injured worker’s case to evidence-based clinical guidelines that outline national standards for a patient with similar symptoms as the one being reviewed. UR often results in a delay or denial of treatment and access to care. Analyzing these disparities can help improve patients' access to appropriate and necessary medical care. A retrospective case series was utilized to analyze existing treatment plans of multiple patients subjected to the UR process. Consent was obtained from an orthopedic private practice located in the Greater Chicago Are...
