What is a URO? Also known as a Utilization Review
In Pennsylvania workers’ compensation law, a Utilization Review, also referred to as a URO is a process used by the workers’ compensation carriers to challenge the reasonableness and necessity of medical care and treatment provided to the injured worker. In Pennsylvania, when medical treatment is rendered to an injured worker, the medical bill, along with the medical notes and other required documentation is sent to the workers’ compensation carrier for expected payment. If the treatment is related to the work injury, but the carrier believes that the treatment is excessive, not reasonable or necessary, then they will send the relevant medical documentation from the medical provider under review to a Utilization Review Organization to make a determination as to the reasonableness and necessity of the treatment that the treating physician or provider gives to the injured worker.
If the URO finds the treatment unreasonable or unnecessary then the Workers’ Compensation Carrier can deny payment of medical bills. If the determination is unfavorable to the injured worker and your medical bill with no longer be paid, you should contact a Workers’ Compensation attorney immediately to file a Petition to Review the URO before a Workers Compensation Judge.
Thank you for taking the time to learn more about workers’ compensation through our Workers’ Comp Wednesdays with Kara Curry on 99.9 The Hawk. If you or a loved one has a question regarding your work injury or claim I invite you to contact me via phone (215) 530-7166, email or the form to the right. As a certified workers’ compensation attorney, I am happy to offer free consultations. – Paula Robinson, Esq.