JENKINTOWN PERSONAL INJURY ATTORNEYS

Utilization review is part of the Pennsylvania workers’ compensation process where an outside medical expert reviews your medical records to determine if the medical treatment or proposed medical treatment is necessary for an injured employee.

In the Pennsylvania workers’ compensation system, there are three primary types of utilization review. They include:

• Pre-clarification Review – This type of utilization review is conducted before any medical procedure or treatment is provided.
• Concurrent Review – This review is carried out as the medical treatment or service is being provided.
• Retrospective Review – This review happens after a medical procedure or service has already been provided.

A Utilization Review must be performed by a qualified medical specialist with the same expertise as the medical provider whose treatment is being reviewed. For example, if an insurance company wants to challenge payment of medical treatment to an injured worker who has been treating with a chiropractor, another licensed chiropractor must review the treatment to determine whether the treatment is reasonable, necessary and related to the work injury. However, that reviewing chiropractor may not review and offer an opinion regarding the treatment rendered by an orthopedic surgeon, for example.

If you are confused or unsure about any part of the Pennsylvania workers’ compensation process, you are not alone. It is important to know that help is available. You are able to meet with an attorney free of charge and without obligation to understand your rights and determine your next steps. As experienced Pennsylvania workers’ compensation attorneys, we understand the nuances of the system and how to fight to get you the benefits you need and deserve. Call Mednick, Mezyk & Kredo today at 888-807-WORK (9675) for your free consultation.