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Attention: Health-Care Providers

Do you treat workers who have been injured on the job? Contact us about working together.

Thousands of workers are hurt in job-related accidents in Pennsylvania each year. The vast majority of them are covered under the Pennsylvania Workers' Compensation Act, which established a workers' compensation system that pays for medical treatment (as well as lost wages). The experienced workers' compensation attorneys at the Law Offices of Richard A. Jaffe, LLC help these workers navigate the system and find the best health-care providers.

Payment

Payments for medical treatment of work-related injuries follow the "90-day rule." Employers have the right to require injured employees to see one of their preferred health-care providers for treatment within the first 90 days following the injury. But in order for this rule to be enforced, employers must meet certain conditions. Among these conditions:

  • The employer must provide clear written notice to the injured worker of his or her rights regarding medical treatment, signed by the employee at the time of hire, and again immediately following the injury.
  • The employer must give employees a list (or panel) of at least 6 health-care providers, with at least 3 being physicians (others can include chiropractors or coordinated care organizations).
  • The health-care providers must have specialties appropriately based on anticipated injuries in the workplace. If a needed specialist is not on the list, the injured worker can choose one of his or her own.
  • The list of health-care providers must be posted in a place where employees would easily see it (such as in a break room).
  • The health-care providers must be located relatively close to the injured worker.

The fact is, not many employers meet all of these conditions. And when they don't, the injured employee is free to choose any health-care provider for treatment, paid for by the employer's workers' compensation carrier. In all cases where surgery has not been recommended, injured workers can be treated by a health-care provider of their choosing, if treatment is still needed.

Paperwork

In order to receive payment, a health-care provider must file a Medical Report Form with the employer's workers' compensation carrier. This report needs to be filed with the carrier once within the first 10 days of beginning treatment, and once a month after that for as long as treatment is given.

If there is a dispute about the amount and/or timeliness of payment, a health-care provider can file an Application for Fee Review. It must be filed no later than 30 days after notification of a disputed treatment (or 90 days following the original billing date of the treatment that is the subject of the dispute, whichever is later).

Review

If the workers' compensation carrier wants to dispute the necessity or reasonableness of treatment, it has the right to file a Utilization Review Request within 30 days of receiving a bill. A Utilization Review Organization (URO) will conduct a review. It's extremely important to cooperate with the review. Failure to discuss treatment or provide records will result in a final decision that the treatment was not reasonable or necessary.

Let's discuss working together to help injured workers get the care they need. Call the Law Offices of Richard A. Jaffe, LLC at (215) 496-9607 or send us a message on our contact page.