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
UR-GENERAL REQUIREMENTS
Section 127.405 - UR of medical treatment in medical only cases

Universal Citation: 34 PA Code ยง 127.405

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

(a) In medical only cases, when an insurer is paying for an injured worker's medical treatment but has not either filed documents with the Bureau admitting liability for a work-related injury nor has there been a determination to the effect, the insurer may still seek review of the reasonableness or necessity of the treatment by filing a request for UR.

(b) If the insurer files a request for UR in a medical only case, the insurer is responsible for paying for the costs of the UR.

(c) If the insurer files a request for UR in a medical only case, then the insurer shall be liable to pay for treatment found to be reasonable or necessary by an uncontested UR determination.

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