What is a Utilization Review Request & What Happens After You Receive It?

In this video, Attorney Tom Wilken details the Pennsylvania Workers’ Compensation Utilization Review Request that says your Medical Treatment will no longer be covered…and what you should do.

If you have received a Utilization Review request for your workers’ comp issue, contact us at 1-877-291-4722 and let us see if we can help you.

Video Transcription:

Hello, my name is Tom Wilkin. I’m a Pennsylvania workers’ compensation attorney with Calhoon and Kaminsky P.C. We’re here today to deal with the situation involving a utilization review request.

What normally happens with that is you get a piece of paper in the mail saying they’re seeking to stop the treatment of your doctor because his treatment is not reasonable, necessary and related to your care. Once that’s filed, the decision will be issued either favorably to your doctor, or unfavorably. One of the most important facts is once that’s filed your doctor’s payments will stop. Your doctor will then have to make a decision as to whether or not he wishes to continue treating you, in spite of the utilization review request. If the case is favorable to your doctor, the treatment will continue, and the insurance company is obligated to pay you regardless of what they may say in the future, and whether or not they appeal it. If you lose and the treatment is found not to be reasonable, necessary or related, you must file an appeal or risk not being able to be seen by that doctor.

If you have questions about this or any other workers’ compensation matter, please feel free to contact us.