I have been in a workmans comp case for over ten years now,and have seen most everything that could be involved with these cases. The new situation im dealing with now is a UR of my providers. I have has a previous UR of providers and everything turned out in my favor. This recent UR was of three providers and the result was two of them came out positive for me but the third result was not. It was found that medical care was not reasonable due to provider not proving records. I actually called and talked to UR company and was confirmed that they did not do review because records finially came through without providers verification. I am inprocess ofcontacting provider to find out what happened. My first question is since it was a negative result based on no review actually taking place can insurance company use this to not pay provider? Actually I know they can but has anyone seen them doing it? it seems kind of pointless to try. Secondly would it be advisable to put in an appeal to this since there was really nothing to challenge because review of provider was not done so what would I appeal? lastly one option I was thinking was for me to do a UR of the same provider making sure review actually goes through, since I am 99 percent it would be a positive result. Just wondering if anybody seen this or similiar before and looking for any ideas.