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Research Brief
Utilization Review in California’s Workers’
Compensation System:
A Preliminary Assessment
July, 2001
Division of Workers’ Compensation
Public Health Institute
Department of Industrial Relations
Berkeley, California
State of California
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Utilization Review in California’s Workers’ Compensation System: a preliminary assessment.
Division of Workers’ Compensation Research Brief 2001-3
Report prepared by:
Linda Rudolph, M.D., M.P.H., Division of Workers’ Compensation
Joshua Linford-Steinfeld, Public Health Institute
Kathy Dervin, M.P.H., Division of Workers’ Compensation
This project was partially funded by the Robert Wood Johnson Foundation Workers’
Compensation Health Initiative. We appreciate the technical assistance of Mark Johnson and Pat
Kirby, DWC, and the individuals at the Workers’ Compensation Appeals Board who identified
cases and made case files available for review.
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Executive Summary
Utilization management is a set of techniques used to manage health care costs through the
assessment of the appropriateness of care in individual cases. The primary focus of utilization
management is reduction of the use of unnecessary or inappropriate medical services. The
Division of Workers’ Compensation (DWC) promulgates “Utilization Review Standards”
pursuant to California Labor Code Section 139. The utilization review (UR) standards govern
the conduct of utilization management or utilization review by workers’ compensation claims
administrators in California.
While utilization review is ubiquitous in health care, little is known about how it has been
implemented in California’s workers’ compensation health care system, and few studies have
assessed its impact on costs in workers’ compensation health care. The impact of UR on quality
of care is also currently unknown. The purpose of this preliminary assessment was to:
o Review the summaries of utilization review plans of California’s largest workers’
compensation claims administrators, to learn more about UR in our workers’
compe