Attorneys Farrell and Edwards Successfully Defend Workers' Compensation Challenge For Client

Attorneys Farrell and Edwards
Attorneys Farrell and Edwards

The Commonwealth Court of PA decided in favor of the client represented by Attorneys Farrell and Edwards, that the Workers' Compensation Judge does not have jurisdiction to review a Utilization Review Determination where the Provider under review fails to provide medical records to the reviewer. The Court also held that denying the Claimant the right to a hearing did not violate the Claimant's right to due process because the Claimant does not have a property interest in his future medical treatment.

A utilization review doctor did not violate the due process rights of an injured worker by denying a medication and injection regimen after a treating physician failed to submit medical records to justify the treatments, the Commonwealth Court of Pennsylvania decided Friday.

Michael Farrell, one of the Mette, Evans & Woodside attorneys representing Fisher Auto Parts', argued that because the utilization review doctor had deemed the Claimants treatments no longer reasonable or necessary, the Claimant no longer had a property right to them.

The Workers' Compensation Appeal Board sided with Attorneys Farrell and Edward's client, overturning the order of a workers' compensation judge who decided that the Claimant had proved he needed the treatments. The WCAB said that the judge lacked subject matter jurisdiction over UR denials due to a lack of medical records.

Attorney Farrell said he thinks the Commonwealth Court made the right call in this constitutional challenge. "The due process argument that was raised makes (this case) unique, and I think the court actually decided it correctly – there was no violation of the procedural due process of the Claimant of this case," Farrell said. "The court indicated there was no identifiable property right of the Claimant that had been denied."


IN THE COMMONWEALTH COURT OF PENNSYLVANIA

OPINION BY PRESIDENT JUDGE LEAVITT
FILED: January 12, 2018

Timothy Allison (Claimant) petitions for review of an adjudication of the Workers' Compensation Appeal Board (Board) holding that the Workers' Compensation Judge (WCJ) lacked jurisdiction to hear Claimant's appeal of a utilization review determination. In this appeal, we consider whether a WCJ has jurisdiction to review the reasonableness and necessity of Claimant's medical treatment where, as here, Claimant's provider did not provide medical records to the utilization review organization (URO) but a peer review report was nevertheless prepared. We also consider whether the Board violated Claimant's due process rights by denying Claimant a right to appeal the URO determination.

READ FULL DECISION


WorkCompCentral.com Article

Court Rejects Constitutional Challenge to UR Provision
by Emily Brill

A utilization review doctor did not violate the due process rights of an injured worker by denying a medication and injection regimen after a treating physician failed to submit medical records to justify the treatments, the Commonwealth Court of Pennsylvania decided Friday.

READ FULL ARTICLE


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