UR policy and procedures must be filed with whom?

UR policy and procedures must be filed with whom?

• A. Administrative Director
• B. Medical Director
• C. WCAB
• D. Director of Industrial Relations

Answer: (A)

Utilization Review policies and procedures for California workers’ compensation plans are filed with the Administrative Director of the Division of Workers’ Compensation. The Administrative Director oversees UR programs, ensures alignment with MTUS and statutory requirements, and has authority to review and audit UR decisions to protect workers and maintain consistent, lawful medical decision-making across plans. The other entities serve different roles: the Medical Director is an internal medical authority for the plan, the WCAB handles disputes and hearings, and the Director of Industrial Relations oversees broader labor and employment issues. Therefore, filing UR policies with the Administrative Director is the correct requirement.

Utilization Review policies and procedures for California workers’ compensation plans are filed with the Administrative Director of the Division of Workers’ Compensation. The Administrative Director oversees UR programs, ensures alignment with MTUS and statutory requirements, and has authority to review and audit UR decisions to protect workers and maintain consistent, lawful medical decision-making across plans.

The other entities serve different roles: the Medical Director is an internal medical authority for the plan, the WCAB handles disputes and hearings, and the Director of Industrial Relations oversees broader labor and employment issues. Therefore, filing UR policies with the Administrative Director is the correct requirement.