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Causally Related Denial of Medical Bills

There has been a recent change concerning Workers’ Compensation. In Pennsylvania, a recent case now permits insurers to deny a claim if the medical bill is not found to be causally related to the work injury. This type of decision can occur after Workers’ Compensation has been awarded.

If the medical provider has not provided enough support to show that the medicine or other prescribed activity or service is not related closely enough to be work-related, it may be denied and the prescriber would need to request a utilization review in order to obtain coverage from the employer.

Painkiller Cream Denial

In the case at issue, a medical provider prescribed a painkilling cream to be applied to an injured worker’s shoulder. The coverage for the prescription cream was denied. The Pennsylvania law requires that there be a causal relationship between the treatment under review and the injury which was sustained at work.

In the past, this sort of detailed denial and review was not conducted or scrutinized in this way. Previously, the court framed the issue by pointing out that the issue of causation between the injury and the workplace is separate from reasonableness and necessity of medical treatment.

In other words, causality had no relationship with whether the medical treatment was reasonable. These two issues are no longer separate and distinct from one another and causality can now play a factor into whether the treatment is deemed reasonable and necessary.

Legal Analysis of Conflicting Workers’ Compensation Opinions

Pennsylvania courts have not yet resolved the exiting conflicting opinions in this area. Under new opinion, more medical providers such as pharmacies and other health care providers, will need to provide notice and an opportunity to participate in the utilization review process and subsequent litigation.

It is questionable whether they will want to get involved since it may require obtaining legal counsel and other more complex steps for Workers’ Compensation patients to receive coverage for their prescription drugs or other medical devices.

In the most recent case, the court does not explain why a pharmacy should be able to participate in disputes linked to reasonableness and necessity in the medical field. Additionally, due process and other procedural questions arise as a result of these conflicting legal opinions in the state.

Delaware County Workers’ Compensation Lawyers at the Law Office of Deborah M. Truscello Can Assist if You Have Experienced an Injury at Work

If were injured as a result of an accident or a mishap at work, you may be eligible for compensation. Our Delaware County Workers’ Compensation lawyers at the Law Office of Deborah M. Truscello can assist you in seeking Workers’ Compensation and help determine if you have other cause for action against your employer. Additionally, we can explain the practical results of recent decisions in the courts. Contact us online or call us at (610) 892-4940 to schedule a free consultation today. Located in Media, Pennsylvania, we also serve clients in Bucks County, Chester County, Delaware County, Lancaster, Montgomery County, Norristown, Philadelphia, Reading, and West Chester.

Contact the Law Office of Deborah M. Truscello

To discuss your case in a free, confidential consultation with attorney Deborah M. Truscello, Esq., call or fill out the form below. 

From our office located in Media, PA we serve the surrounding areas of

  • Bucks County
  • Chester County
  • Delaware County
  • Montgomery County
  • Philadelphia County
Including but not limited to
  • Allentown
  • Lancaster
  • Reading
  • West Chester

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Reasonable Rates & Fees

For Personal Injury, Workers’ Compensation and Social Security Disability cases, we have a contingency fee based on a percentage of what we obtain for you. We will not charge you any fee unless and until we settle your case, prevent the loss of your benefits or obtain benefits for you. 

For Family Law clients, we understand that financial difficulties often accompany divorce and other family law issues. Ask us about our reasonable and competitive hourly rates for your situation. 

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testimonials

Why Clients Choose Deborah

Heather A
2023-03-01
I have known Deb for years now and it all started in 2009 when I got hurt and needed legal help with my workers comp. I randomly chose Deb because of the things I read on her website and I liked that she had a take charge attitude about just about everything. She out-lawyered someone and got me more in a settlement for that and then also worked with me on another case and won that one as well for me. If you get to know Deb and her personal story, you will get to know an amazing single mom who has had her own struggles and has come out so much stronger. She will fight for you if you do your part as a client and follow her guidance. I have now used two women lawyers in Media and three men and I actually found the two women far more effective and both won my cases that the men lost. Without Deb and my other lawyer winning the cases for me that they did - I could have found myself disabled for good with no money to pay for the life I live because I can’t work now. I credit my ability to be able to eat and have transportation and all. I couldn’t be more grateful for their hard work they did for me. Deb has won two of my cases and I would absolutely refer others to her for the same kinds of cases and I would use her again if I ever needed her help again!
Daveen Carpenter
2019-10-08
Deborah's team went above and beyond to get my case settled quickly. I am forever grateful
Rebecca Porter
2019-09-24
If you ever need a worker’s compensation attorney, I highly suggest using Deborah Truscello. I had a work accident injury and was referred to Deborah. She was with me every step of the way, with this long-drawn-out process. She was there any time I had questions or needed advice on my rehabilitation. Now my case is settled. I am very happy how things turned out and I owe it all to her. I can't thank her enough. I will use her again if I ever need too.
Jackson Jones
2019-09-01
Deborah is an excellent lawyer. She was professional, knowledgeable, and made me and my case feel important. She was always accessible and answered all of my questions. I would definitely recommend Debbie to anyone injured at work and in need of legal services.
K M
2019-05-18
I am a client of Deborah Truscello and also a woman of color. Deborah Truscello is not a bigot nor is she a racist. I hired Ms. Truscello back in 2016 for a very nasty custody case against a crazy man who has a history of dragging all his children through the court system. Ms. Truscello has been nothing but professional and well organized. She is very reliable and always available. I could contact her any time of the day or night and she is always responsive to my text messages, calls, and emails. If you are considering hiring her as your attorney I highly recommend you schedule a consultation and see for yourself you will not be disappointed.
Andrew Kriegh
2018-08-17
Amazing law firm, they have helped me so much and enlightened me to the options I have, and to the right doctors who are still treating my issues... Very professional and very great people glad to have her in my team!!

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