COVID-19 Resource Center

March 27, 2007

Court Confirms Narrow UR Determinations

Although a prospective Utilization Review (UR) Determination was partially favorable to the employer, it was held to be invalid because the claimant had not treated with the named provider for months. Despite the notation on the UR Request that it apply to all providers of the same license and specialty, the Court held that one UR can only apply to a single individual provider. 

What It Means to You

Precision and thoroughness are important when filing Utilization Review requests. Separate requests must be completed for each individual provider, including multiple doctors in the same office. Contact a Cipriani & Werner attorney to discuss the best procedure for challenging the compensability of a claimant's treatment in your case.

Sources

Bucks County Community College v. WCAB (Nemes, Jr.), A.2d (Pa. Cmwlth. 2007)