In our last post, we began with the topic of employers who refuse to cooperate with injured workers who file for workers’ compensation claims. The first case we discussed involved an employer who lost on appeal. In this post, we’ll talk about a recent case in which the Commonwealth Court of Pennsylvania ruled in favor of an employer.
The issue in the case was whether a worker who injured his back was entitled to receive a copy of a utilization review determination requested by his employer. Utilization review, for those who don’t know, refers to the process of having a third party conduct a review regarding the medical necessity of a course of treatment. Employers are able to request utilization reviews for medical treatment received by injured employees.
In this case, the utilization review was ultimately in the worker’s favor, but his objection was that he never would have had the opportunity to challenge it since it wasn’t delivered to him. According to the court, though, there are no statutes or regulations which require employers or their insurance carriers to present the results of a utilization review to an injured employed.
The finding is important since it shows that injured employees need to be aware of the need to advocate for themselves. Employers simply don’t always have the interests of their injured employers at heart.
Workers who face difficulties with an employer over an injury compensation claim should certainly speak with an experienced attorney to have their case evaluated. Doing so may be the first step to a positive resolution.
Business Insurance, “Pa. employers needn’t notify comp claimants of utilization review: Court,” July 18, 2014.