Medical Treatment Review
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
BUREAU OF WORKERS' COMPENSATION
1171 South Cameron Street, Room 103
Harrisburg, PA 17104-2501
The Pennsylvania Workers’ Compensation Act provides for the process of medical treatment review under Section 306(f.1)(6) of the Act. This utilization review process provides for the impartial review of the reasonableness or necessity of medical treatment rendered to, or proposed for, work-related injuries and illnesses.
Utilization review of medical treatment is conducted by Utilization Review Organizations (UROs) authorized by the Secretary to perform utilization reviews for Pennsylvania workers’ compensation.
A utilization review may be requested by or on behalf of the employer, insurer or employee. Requests for utilization review should be filed online in the Workers’ Compensation Automation and Integration System (WCAIS). Parties who disagree with the findings of the utilization review may file a petition for review to be heard and decided by a workers’ compensation judge.
The Medical Treatment Review section of the Act also includes provisions for Peer Review. A peer review opinion is requested by a workers’ compensation judge when questions concerning necessity or frequency of treatment arise during a utilization review petition or other litigation proceedings.