ARTICLE · 19 JULY 2023

Removing The Teeth Of Utilization Reviews

Collins Einhorn Farrell

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At first glance, the no-fault reform legislation's introduction of utilization reviews for no-fault medical claims signaled promising days ahead for insurers and providers.

United StatesInsurance

Nicholas Badalamenti

Introduction

At first glance, the no-fault reform legislation's introduction of utilization reviews for no-fault medical

claims signaled promising days ahead for insurers and providers. Insurers could avoid lengthy and costly litigation if it challenged the frequency of or indications for treatment. Providers could likewise challenge denials in an efficient manner through the same process. However, the process only provides those benefits if it's a mandatory administrative process. The Court of Appeals recent decision in True Care v Auto Club Group upended the utilization review process by finding that it is not a mandatory administrative process, placing the future of the utilization review system in doubt.

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