Pennsylvania Code
Title 34 - LABOR AND INDUSTRY
Part VIII - Bureau of Workers' Compensation
Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT
Subchapter C - MEDICAL TREATMENT REVIEW
PEER REVIEW
Section 127.618 - Duties of reviewers-finality of decisions

Universal Citation: 34 PA Code ยง 127.618

Current through Register Vol. 54, No. 38, September 21, 2024

(a) Reviewers shall make a definite determination as to the necessity and frequency of the treatment under review. Reviewers may not render advisory opinions as to whether additional tests are needed. In determining whether the treatment under review is necessary, reviewers may consider whether other coursers of treatment exist. However, reviewers may not render advisory opinions as to whether other courses of treatment are preferable.

(b) If the reviewer is unable to determine whether the treatment under review is necessary or of appropriate frequency, then the reviewer shall resolve the issue in favor of the provider under review.

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