Commonwealth Court Issues Decision on Utilization Review of Medical Treatment

Date: August 4, 2009

In Sexton v. WCAB (Forest Park Health Center), the Pennsylvania Commonwealth Court has held that a utilization review organization (URO) had no choice but to deem injections received by a claimant for pain relief due to her work-related back injury unreasonable and unnecessary as the claimant’s medical records were not properly submitted to URO due to lack of required verification form signed by the claimant’s medical provider who’s treatment was being reviewed. The Court held that the submission of a signed verification form from provider was mandatory and the failure to provide the signed verification form to the URO was same thing as providing no medical records. Thus, without such a form, the URO could not say with certainty that the records were accurate.

Joe Price
Attorney Joe Price is a seasoned Trial Lawyer serving Northeast, Central and Southeast Pennsylvania for the past forty (40) years. He has handled serious personal injury cases in courts throughout the Federal system including New Jersey and New York. Attorney Price is A.V. Rated by Martindale Hubble. He is Board Certified in Civil Practice by the National Board of Trial Advocacy since 1996.