Workers Compensation 101 for Safety Professionals ：工人赔偿101安全专业人员.pptVIP

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Workers Compensation 101 for Safety Professionals ：工人赔偿101安全专业人员.ppt

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Workers Compensation 101 for Safety Professionals ：工人赔偿101安全专业人员

* * * * Workers Compensation 101 for Safety Professionals What Will Happen At The Hearing? The WCJ will ask both parties what evidence they intend to present. One or both parties may present testimony, submit documents, or both. The WCJ will set a schedule for the submission of all other evidence. The WCJ will set a schedule for presentation of evidence and submission of briefs. The Act provides that the WCJ may amend this schedule for good cause. The WCJ will schedule mandatory mediation (i.e., mediation required by the Act), unless he/she finds that it would be futile. More information concerning the WCJs first hearing procedures may also be obtained at the Office of Adjudication Judgebook. Workers Compensation 101 for Safety Professionals What is a Utilization Review ? Is this helpful for an employer? Employers can file utilization reviews (UR) in order to challenge the reasonableness or necessity of medical treatment a worker receives. The employer files a request with BWC, which assigns the request to a Utilization Review Organization (URO). Injured workers have the right to supply a personal statement to the reviewer explaining why the challenged treatment is necessary or helpful. The provider under review also has the opportunity to speak with the reviewer. Any party dissatisfied with the URO’s determination may file a petition with the Office of Adjudication. A WCJ will take evidence and render a decision. Workers Compensation 101 for Safety Professionals What Is an IME? Does the claimant have to attend the IME? Section 314 of the Pennsylvania Workers Compensation Act provides that the employer/insurance company is entitled to have the claimant examined by a doctor whom it chooses at a reasonable time and place. These doctors are not the treating doctors and are being paid by the employer/insurer to perform this evaluation. Some judges have interpreted this provision to allow for such an examination twice a year. Although the claimant is