I found this little tidbit of info while purusing a WC forum..
The way to defeat UR decisions is complex and difficult. Have your attorney or doctor demand a copy of the complete UR decision and the employers UR plan and name of CA. physician overseeing the treatment plan.
The physician that is rebutting the UR decision must use a scientific approach, with treatment plan protocols prescribed. Protocols offered by the Primary Treating Physician (PTP) need substancial medical reporting to rebut the UR decision with Evidence Based Medicine (EBM).
UR uses ACOEM Guidelines which are presumed to be correct treatment protocols....
*** then there was a mention of some flaws with the ACOEM however, this gives at least some guideline or format for one working with WC UR denials to rebutt decisions...
This would be me....
Wishing anyone else with this process going on good luck...
