How Will a Utilization Review Affect My Case? - Luxenberg Garbett Kelly & George P.C.

From Luxenberg Garbett Kelly & George P.C. – How Will a Utilization Review Affect My Case? examines the often-overlooked process that can significantly impact your workers’ compensation claim, especially in Pennsylvania. This episode explores how utilization reviews (URs) are initiated by insurers to evaluate whether medical treatments align with clinical standards, potentially influencing your access to care. We discuss what happens when treatments are questioned and how UR decisions can delay claims or deny coverage altogether.

Listeners will gain insight into the three main types of utilization reviews in Pennsylvania workers’ compensation law: prospective, concurrent, and retrospective. We break down how each type functions, from pre-authorization for procedures like MRIs to real-time evaluations during hospital stays, and post-treatment reviews following the submission of medical bills. By understanding these distinctions, injured workers can better prepare for challenges to their medical care and know when legal support may be essential.

The episode also addresses what injured workers can do when faced with a utilization review. From reviewing official notices to potentially submitting personal statements, we cover the steps you can take to stay informed and involved. If treatment is denied, we guide you through the appeals process, including filing a Petition for Review with the Pennsylvania Bureau of Workers’ Compensation, and emphasize the importance of meeting deadlines and providing solid documentation.

Finally, our team at Luxenberg Garbett Kelly & George P.C. offers actionable advice on how to protect your medical benefits when a utilization review disrupts your care. We explain why insurers initiate these reviews, who pays for them, and what rights you have under Pennsylvania law, especially when it comes to denied or delayed treatments. If you’re navigating the complex landscape of workers’ compensation and facing barriers to care, tune in to learn how our legal team can advocate for your recovery and financial stability.

Luxenberg Garbett Kelly & George P.C.

315 N Mercer St, New Castle, PA 16101, United States

(724) 658-8535

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