Synopsis: One of the Best Defense Tools in IL WC—Utilization Review.

Editor’s comment: I am handling a pending IL WC claim where Claimant has attended over 60 PT visits and wants another dozen more! What is the best way to block such obvious over-utilization? UR!!!


I feel so strong about this defense concept, I reached out to Jill Pessman from Triune Health Group for her thoughts and assistance.


Please note my strong opinion the best thing about prospective UR is simple—when you use UR, you aren’t worried about politics in a liberal IL WC Commission. You are concerned with the “science” that UR brings to the claims table long before you litigate any issue.


Please further note the number one cost in WC across the globe and in your WC claims is medical. If you can control medical costs, you can control WC costs. In my view, the fastest and easiest way to control medical costs in IL WC is to start with UR early and use it often. The physicians and surgeons subject to UR analysis aren’t always thrilled about a UR determination and they can file a UR appeal to insure a specialist looks at the same chart they are looking at. The UR appeal is quick and generally painless—either the UR specialist certifies or they don’t. And please note the UR appeal isn’t decided by an IL WC Arbitrator or Commissioner.


Please also remember this is a method to block what I call “stupid medical stuff.” If a doctor recommends “medial branch blocks” or “trigger point” injections or a “discogram,” you may be able to cut such silliness off before it enters the WC medical chart.


And what might be the very best thing for any pending WC claim—when UR stops/blocks further care, Claimant is MMI and you can usually stop TTD and then move at that point to seek settlement of litigated claims. If you aren’t sure, send a reply!!!


How Do You Put UR on Your IL WC Claims?


With Triune (and other UR providers), all of your Utilization Review (UR) needs are just a click away!  Here is a safe link: Utilization Review Referral | TRIUNE Health Group


What can UR do for you?


  • Provide a sense of direction on a file ensuring medical necessity of proposed treatment (surgeries, injections), concurrent treatment (ongoing therapy or medication use) or retrospective treatment (all aspects of completed care). A UR allows you to stop payment for treatment that should not be considered, is not appropriate or not in the best interest of the injured worker.

  • Provide a solid defense as URs are backed by guidelines and not a physician’s opinion making them strong at the Commission level.

  • Addressing ongoing treatment informs the treating MD that someone is watching their plan of care and treatment is not open ended.

  • Cost savings, of course! A UR is an inexpensive, quick tool (turnaround time 1-5 days if all medical records are included with the referral) that will allow you to deny unnecessary and excessive treatment. Physical Therapy and Chiropractic Therapy are two major areas being over-utilized by treating physicians; a UR will provide you the means to stop treatment when it is not medically necessary.


At TRIUNE Health Group they have a dedicated and experienced Utilization Management registered nurse handle your referral from start to finish. They review each and every record ensuring a complete set of medical records is available to their reviewing physician. If records are missing, they take immediate action to obtain them, as they want to provide you a highly defensible UR. They strive to only use licensed and actively practicing Illinois physicians to complete Utilization Reviews.


Triune Health Group Utilization Review Team

Direct line: 630 522 8927

Jill Pessman, RN

Amanda Yale, RN


Please note I am not paid for nor do I have any financial interest in Triune Health UR. While I recommend them, there are lots of other great UR providers to choose from in managing IL WC claims. I appreciate your thoughts and comments. Please post them on our award-winning blog.


Synopsis: Indiana Governor signs new bill protecting Indiana businesses and others from COVID-19 claims. Article and analysis by our Indiana WC Defense Team Leader, Kevin Boyle, J.D

Editor’s comment: Last week, the Indiana Governor signed a new law that gives broad protections to Indiana employers, manufacturers, businesses and others from lawsuits that could blame them for contracting COVID-19. This law blocks tort claims, including class actions, against companies, governments, and individuals who are accused of negligently spreading the virus, like a “liability shield” similar to those enacted by several other states.

The bill also benefits the broader drug and medical supply industry by blocking liability for makers and suppliers of medicines, protective equipment, supplies, and tests used to prevent the spread of Covid-19 or treat the disease.

The law (Senate Enrolled Act No. 1, First Regular Session of the 122nd General Assembly (2021) is retroactive to March 1, 2020 (the date just before the first coronavirus infection was confirmed in Indiana), and only allows lawsuits against businesses when “gross negligence or willful or wanton misconduct” that can be proved by “clear and convincing evidence.” Issues were raised about whether it will block lawsuits against nursing homes over illnesses and deaths among residents. However, the bill sponsor indicated that questions about whether to shield nursing homes and other medical providers from lawsuits will be addressed in a separate bill that will go before legislators later during this year’s legislative session.

It is also hoped the law saves municipal governments and the Indiana A.G. time and taxpayer dollars by blocking suits by prisoners with claims the government did not protect them from infection while incarcerated.

If you’d like a copy of the new law, let me know. This article was researched and written by Kevin Boyle, JD. Kevin can be reached at