Despite the fact that a worker may be rightfully entitled to Pennsylvania workers’ compensation benefits, insurance companies will do all they can to get out of covering his or her medical bills. One of the most commonly used tactics is a utilization review.
What is a utilization review?
A utilization review is when an insurance company requests an independent evaluation to determine whether or not medical treatment for a work injury is needed. If an insurance company requests a utilization review, the Pennsylvania Bureau of Workers’ Compensation will select what they deem to be a third-party, unbiased medical professional to evaluate the injured person’s condition and decides whether or not treatments were necessary.
Utilization reviews generally have one of three outcomes. One is that the medical treatments for the injured worker were necessary, meaning the insurance company should be held accountable for covering the cost. Another is that the medical treatments were not necessary, meaning that the insurance company should not be held accountable for the medical bills. The third is that some of the medical treatments were necessary, but some extra treatments took place that were not.
After the Outcome
If your medical treatments are deemed necessary, this is great news. Your employer’s insurance carrier is going to have to cover the cost of your medical care. If, however, it is determined that your medical treatments were partially or fully unnecessary and you feel this is unjust, you can petition to have your case reexamined. It is important to speak with your attorney to help decide whether or not this is a good idea.
If have been injured on the job and live in the Harrisburg, York, or Lancaster area, contact PaWorkersCompHelpNow at 877-COMPHELP for a free evaluation. Remember, if you are suffering from a work-related injury, you may be entitled to Pensylvania workers’ compensation benefits, even if your claim has already been denied. Don’t miss out on what you are entitled to.