Does Pennsylvania Workers Comp Require Pre-Authorization?

Pennsylvania Workers Compensation Act DOES NOT require pre-authorization for medical treatment.  I get that question time and time again.  The answer is always the same.  No pre-authorization is required in Pennsylvania.

Quite frankly, this issue arises when a more expensive procedure/treatment is recommended by the treating doctor.  That usually includes an MRI, surgery, or various types of injections. It arises when a treating doctor advises the client (patient) that this is the recommended treatment and we will get it scheduled after the insurance company pre-approves the treatment.  Yet, there is no requirement for pre-approval for an accepted work injury.  Many times the insurance carrier will not provide the pre-approval because they are under no requirement to do so.  What they are required to provide is whether the claim is open.

So what can you do?  Given there is no pre-authorization, sometimes medical providers do not want to provide the treatment.  We can hemp navigate the issues for you.  What we can do as your attorney is call and speak to your medical provider and explain the no pre-authorization requirement.  We explain to them that they can bill workers compensation and provide your private health insurance as a backup insurance.  Sometimes through explanation we can get your doctor to provide the treatment you need.  We can then take the insurance carrier to task and file a petition against the insurance carrier.  Many medical providers we deal with know workers compensation processes and understand the billing process.

If we can’t get your doctor to change their minds on providing you treatment you need, we can file a petition to help get the treatment approved. That takes time to litigate.  Clearly not the best option.  Another option would be for our firm to get you referred to a different medical provider who understands the workers compensation process and will provide the medical treatment.

The moral of the story here?  We can help.  We will help.  If you have been injured at work, going it alone is too complex, confusing, and too many pitfalls await you.  Call Mooney Law today for an absolutely free phone or office consultation.  Mooney Law represents injured workers throughout Pennsylvania and Maryland.  Call us today at 833-MOONEYLAW or 717-200-HELP.





Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.