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Worker Couldn't Rely on UR Determinations to Establish Causation

Monday, August 1, 2022 | 0

The Commonwealth Court of Pennsylvania ruled that utilization review determinations can't be used to establish the causal relationship between a treatment and a work injury, and upheld the denial of a worker’s penalty petition for an employer’s failure to pay for medications that had been approved by UR. Utilization review determinations only decide the reasonableness or necessity of treatments, not the causal relationship to an occupational injury, the court said. "Claimant failed to establish the causal relationship between the prescription medications at issue in this...

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