The Right To Have Your Medical Treatment Pre-Approved By The Workers’ Compensation Carrier

Date: September 9, 2020

Medical Treatment Under the Workers’ Compensation Law

If the workers’ compensation carrier takes the position that they do not have the obligation to pre-approve your medical treatment, their position is wrong.  A workers’ compensation carrier exposes itself to attorney’s fees for an unreasonable contest if it uses the pre-approval excuse for non-payment.

File A Workers’ Comp Prospective Utilization Review

The attorney representing the injured worker can file a petition compelling the carrier to pay which could take an extended amount of time and, in many situations, is not practical.  A quicker solution is to file a prospective Utilization Review Request which is an effective method that forces the carrier to pre-approve necessary medical treatment for the work-related injury.

The advantages of the prospective Utilization Review Request is that the same will automatically generate a letter from the Pennsylvania Bureau of Workers’ Compensation directed to the responsible workers’ compensation carrier.  That workers’ compensation carrier will then have to make a decision whether to agree to pre-approve any bill and thus, not incur the costs of the utilization review requested by the employee.  The employee never has to pay for this cost.  The responsible workers’ compensation carrier is always responsible for paying the costs regardless of who wins.  These prospective utilization reviews can cost the carrier more than $1,000.00.  The carrier is only given a short time to respond to the Bureau as to what the carrier’s position is.  The carrier can agree in writing to pay for the prospective treatment rather than incur the cost.  If the carrier decides that it will not pre-approve the treatment, the matter will be promptly assigned to a utilization review organization and a decision must be issued within thirty days of their receipt of the assignment from the Pennsylvania Bureau of Workers’ Compensation.

In most instances, the injured worker will have a decision, which is usually going to be favorable, within forty-five days from the commencement of the process.  Should the utilization review decision be unfavorable, the injured worker may file a petition to request a review of that unfavorable decision within thirty days thereafter.  At that point in time, the burden of proof shifts to the employer and carrier to show that the request of future treatment is neither reasonable nor necessary before a workers’ compensation judge. If the utilization review finds the treatment is, in fact, reasonable, the carrier must pay for the treatment even if they file an appeal.

Hire A Workers’ Comp Attorney In Pennsylvania

If you need help with a workers’ compensation issue, speak to an experienced Pennsylvania Workers’ Comp Lawyer for free. No matter where you live in the state, we can help. Remember: Injury? Call DLP! (570) C-A-L-L-D-L-P.

Cal Leventhal
Cal is a graduate of the University of Miami (magna Cum Laude) and attended Loyola and Notre Dame law schools graduating in 1976. He is admitted to the Bars of the Supreme Court of Pennsylvania and both state and federal trial and appellate courts situated in Pennsylvania.