When a party wants a utilization review under Pennsylvania workers’ compensation law, it seeks an independent determination of whether a medical treatment for a work injury is reasonable or necessary. The typical workers’ compensation utilization review process begins when the insurance carrier or employer receives the bills for an employee’s medical treatment and believes the… Read more

In a recent study, the Workers’ Compensation Research Institute found that the costs for prescription drugs used to treat injured workers in Pennsylvania were higher than the median cost. The Cambridge, Massachusetts, based research group found that the average payment per claim for prescriptions was $445, which was eight percent greater than the median established… Read more

The Pennsylvania Commonwealth Court recently ruled that in workers’ compensation cases, an expert’s opinion could be held valid even if the expert did not personally examine a specific injury the worker suffered. In Stancell v. Workers’ Compensation Appeal Board, the court affirmed a benefits termination petition after the employer’s medical expert testified regarding the employee’s… Read more

This past fall, the Commonwealth Court of Pennsylvania upheld a ruling that a workers’ compensation insurer can suspend benefits when an injured worker refuses to enter a detox program – despite the fact that completing the program will not treat the injured worker’s underlying medical condition or help her return to her pre-injury employment position…. Read more