What is a utilization review?

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By Joshua B. Goldberg

Workers' Compensation & Personal Injury Attorney

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what is a utilization review? PA workers' compensation attorney explains

A common question I receive as a Pennsylvania workers’ compensation attorney is:

“What is a utilization review?”

Well, we’re going to answer this common workers’ comp question in todays blog post.

Utilization reviews are a common occurrence in Pennsylvania workers’ compensation cases, so understanding what they are is important to your case.

Without further ado, let’s get into it.

What is a utilization review?

A utilization review in Pennsylvania workers’ comp cases is refers to a review of the medical treatment/s prescribed to treat your work injury.

The review is used to evaluate your medical care and treatment for and by a specific doctor.

It can be used to evaluate general doctors visits, or specific treatment that the doctor is providing you, whether that be medication, physical therapy, or some other form of provided treatment for your work injury.

Another doctor will review your prescribed treatments given by your doctor, and evaluate if they are necessary and reasonable for your injury.

Who assigns my utilization review?

The utilization review is assigned to you by the state of Pennsylvania.

The state will also choose a doctor to evaluate your particular set of treatments.

These reviews are done by the state and for the state to make sure that the treatment prescribed to you by one doctor is deemed reasonable and necessary by another doctor of their choosing.

How long does a utilization review take?

The review usually takes about a month or so to have your results returned to you.

After about a month, a report will come back telling you whether or not your treatment is deemed reasonable and necessary by the doctor chosen by the state.

What if my treatment is deemed unnecessary?

If the utilization review is unfavorable to you, you do have 30 days to file an appeal and you would have the right to challenge the determination made by the states doctor doing the review.

If your treatment is deemed unreasonable or unnecessary, you could lose some or all of your benefits.

It’s important to protect your rights in this situation, and you do have an opportunity to do so in the appeal process.

To make sure your rights are protected in this process, it’s best to get the help of an experienced and trusted workers’ compensation attorney in Pennsylvania.

Get help with your Workers’ Compensation Case

If you have a utilization review or any other questions or issues with you workers’ compensation case in Pennsylvania, please give us a call, and schedule a free workers’ compensation consultation with us.

Pennsylvania workers’ compensation attorney Joshua B. Goldberg will hear your case, and provide legal counsel to help you understand your rights and options in your PA workers’ comp case.

Workers’ compensation cases can be complicated, and knowledge and experience in Pennsylvania’s court systems will help you get the compensation you deserve.

We offer free consultations for our workers’ comp clients, and don’t get paid until we win your case.

Contact us today, and schedule your free workers’ compensation consultation with Attorney Goldberg.