DWC posts completed Utilization Review results for claims administrators conducted in 2025

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The Division of Workers' Compensation (DWC) Audit and Enforcement Unit conducts Utilization Review (UR) investigations with its profile audit reviews every five years. UR investigation results for claims administrators in 2025 are posted on the DWC Audit and Enforcement website.

The performance rating is based solely on any additional penalties cited pursuant to California Code of Regulations, title 8, section 9792.12(b). California Code of Regulations, title 8, section 9792.12(b)(1) provides factors for calculation of the performance rating following the review of the sample of randomly selected requests for authorization. The performance rating is a composite score reflecting claims performance in the following areas:

• (b)(1)(A) The percentages of randomly selected requests where there was failure to make and/or provide a timely response to a request for authorization;
• (b)(1)(B) The percentages of randomly selected requests where there were notices with faulty content;
• (b)(1)(C) The percentages of randomly selected requests where there was failure to issue notices to all appropriate parties.
• A Utilization Review Performance Rating of 85% or greater is a passing score.
• Penalties for violations in 8 CCR §9792.12(a) are mandatory and cannot be waived but may be mitigated depending on factors in §9792.13. Penalties under §9792.12(b)(4) and (b)(5) may be waived per §9792.12(b)(2) and mitigated per §9792.13.

For questions please email: [email protected], phone 916.928.3180 or 213.620.2312.