As a consumer, you have the right to:

• expect that any medical records and personal health information have been treated as confidential and protected.

• receive information regarding the Utilization Management determination, including the clinical rationale and clinical criteria used to make the determination.

• be informed of appeal procedures, timelines, and instructions about how to request an appeal.

• request information about how to file a complaint, file a complaint, and receive timely resolution or a referral of the complaint to another entity.

As a consumer, you have the responsibility to:

• provide the most accurate and complete information to your healthcare provider regarding your clinical history.

• be familiar with state laws and how they affect your workers’ compensation claim.