The Insurance Company will review your treatment plan and cut off your medical benefits immediately. This review has less to do with your physical rehabilitation and more about the cost of your medical treatment.
The review that takes place is a comparison of your treatment to ODG guidelines.
ODG or Official Disability Guidelines (ODG), prepared by the Work Loss Data Institute, is a private organization funded by the insurance industry. The guidelines ODG provides are based on an aggregate of millions lost-time cases.
If the treatment plan does not conform to ODG guidelines, the insurance company will refuse to authorize treatment.
There are times, when the treatment is approved through a utilization review. Many more times, utilization reviews are used to cut off injured workers benefits and medical.
Thankfully, we know how to overcome the insurance company’s arguments to get your treatment authorized.