Insurance Company Challenges to Work Injury Medical Treatment in Pennsylvania

Greg Boles
Connect with me
Partner at The Boles Firm | Experience Matters

Does your employer have the right to challenge whether you are receiving reasonable and necessary treatment for your work injury?  The answer is yes, but it's a very cumbersome process.  If they have accepted legal responsibility for your claim and they're paying medical bills associated with your injury, to challenge the reasonableness of your treatment they have to file a utilization review request.   An utilization review request is assigned to a Utilization Review Organization by the Pennsylvania Bureau of Workers' Compensation.  That organization will then make a request to your doctor to send all of your medical records to them.  You have the right to give a written statement describing how the treatment helps you.  Once that information is gathered, the information is sent to a reviewing physician, and the physician will then make a decision about whether your treatment is reasonable and necessary.  If he rules against you, you do have the right to file an appeal, but so does your employer.  The burden of proof, whenever you go in front of a Workers’ Compensation Judge on such a matter, is on your employer or its insurance company. for more detailed information on workers' comp medical billing, click here