Harrisburg Utilization Review Lawyer
You notified your employer of your injury, sought medical care, filed a workers’ compensation claim, and went through all of the necessary steps in order to secure medical benefits. It seemed like all of the hard work and challenges had been taken care of, but now another issue has arisen in the form of a utilization review. Unfortunately, this type of insurance carrier or employer complaint is all too common in workers’ compensation cases. After all, there is a reason why the workers’ compensation insurance sector is one of the most profitable, according to Captive—insurers have massive power of injured workers, and will take every measure possible to reduce benefits.
If you are being required to go through with a utilization review, you need to contact an attorney to make sure your interests and rights are protected, and that you are not unfairly kicked off of workers’ compensation benefits. Our Harrisburg utilization review lawyers at Ira H. Weinstock, P.C. can provide you with professional legal assistance for every step of this process, and hold your employer and their insurance carrier accountable for the continued medical treatment that you need and were promised.
When are Utilization Reviews Requested?
Sometimes, employers and insurance companies will fight a workers’ compensation claim every step of the way, even after the claim was initially accepted and benefits were paid out. A utilization review occurs when an employer or insurer believes that the medical care you received was unnecessary or unreasonable. The treatment could have been in the form of physical therapy, medication, surgery, or some other procedure that was recommended by your healthcare team, yet for some reason raised a red flag with your employer or their insurance carrier. At this point, they will request a utilization review.
What is a Utilization Review?
A utilization review is an exam by a third party utilization review organization (URO). According to Pennsylvania’s Department of Labor, it is an “impartial review of the reasonableness or necessity of medical treatment rendered to, or proposed for, work-related injuries and illnesses.” While these medical professionals are claimed to be neutral, they are essentially working for your employer or your employer’s insurance carrier, and therefore do have a bias. This party then reviews your medical condition and the treatment you were given to determine whether it was reasonable. You are able to include reasoning and additional evidence as to why the treatment was needed at this time. If the URO determines that the treatment was not warranted, your medical benefits could be reduced, stopped, or you could be forced to pay for the treatment out of pocket.
What if the URO Claims That Treatment Was Not Necessary?
If your treatment was denied, you have two options: accept the ruling and submit to the financial penalties of paying for the treatment on your own, or take the matter to trial before a judge.
Contact Our Harrisburg Workers’ Compensation Attorneys
If your medical treatment is going to be reviewed, or it has already been reviewed by a URO, you need to contact an attorney before your benefits are stopped or reduced. You should not have to be financially liable for an injury that occurred on the job. Call our Harrisburg workers’ compensation attorneys at Ira H. Weinstock, P.C. today at 717-238-1657 to schedule a free consultation.