Insurance carriers and defense attorneys often invoke this label to delay treatment, deny payment, or argue that a doctor ordered "too much" care after a job injury. What it actually means is a formal review of medical treatment to decide whether the care is medically necessary, reasonable, appropriate, and related to the injury. The review may look at office visits, imaging, surgery, physical therapy, prescriptions, or durable medical equipment, and it is usually performed by nurses, physicians, or contractors working for the payer.

In practice, utilization review can shape whether an injured worker gets prompt care or ends up in a dispute over medical benefits. A negative review may lead to a refusal to authorize treatment, a cutoff of ongoing care, or a challenge to bills already submitted. That can interrupt recovery, extend disability time, and create evidence the defense later uses in a hearing on causation, disability, or wage loss benefits.

In Michigan workers' compensation cases, the employer must furnish reasonable medical care for a work-related injury under MCL 418.315(1). A utilization review does not automatically decide the case; it is one piece of evidence. If the insurer relies on it to deny care, the worker may need supporting records and a treating doctor's opinion to contest the denial before the Michigan Workers' Compensation Agency.