I am in pain and I want to be treated by a certain doctor. My workers’ compensation insurance adjuster said that they won't pay that particular doctor’s bill or for the particular procedure that my doctor says that I need. Is this legal?
Yes. There is no requirement under the Pennsylvania Workers’ Compensation Act for the insurance company to "pre-authorize" any type of medical treatment. The insurance company is only required to pay for reasonable and necessary medical treatment after the treatment has been given by the provider and the bill has been properly submitted to the insurance company. The bill must be paid within thirty (30) days after the medical provider has submitted the bill on a required form and with a medical report setting forth the reason and necessity of the treatment.
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