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.