Workers’ Compensation - Utilization Reviews - Commonwealth Court of Pennsylvania (En Banc)

Summary of Pennsylvania Decisions

Gazzola v. Workers’ Compensation Appeal Board (Ikon Office Solutions) No. 1138 C.D. 2006 (November 22, 2006)

Holding: A WCJ has jurisdiction to rule upon the adequacy of a Utilization Review Organization's pursuit of records, including whether (1) records were mailed in a timely manner or (2) there was a reasonable excuse for not supplying records in a timely matter or at all. The WCJ canthen decide whether to uphold the determination based on the failure to provide records or vacate the determination and order records to be sent to a reviewer for a URO determination on the merits of whether the treatment was reasonable and necessary. The WJC cannot rule, however, on the merits of whether the treatment was reasonable and necessary.