A request for utilization review by the employer does not constitute an admission of causation or prohibit the employer from denying causation.

The claimant began receiving workers' compensation benefits for a work-related low back strain and sprain pursuant to a Notice of Temporary Compensation Payable that later converted to a notice of compensation payable. Later, the claimant began to treat with a psychiatrist, and the employer filed a utilization review request (UR) seeking prospective review of the psychiatric treatment the claimant was receiving. Ultimately, the UR Determination found that all of the care was reasonable and necessary. The employer did not appeal. The claimant then filed a Review Petition, seeking to amend the description of his work injury to include depression and anxiety. In support of that petition, the claimant simply argued that the employer was estopped from disputing causation by virtue of the unappealed UR Determination. The workers' compensation judge agreed, and the petition was granted. The Workers’ Compensation Appeal Board affirmed. The Commonwealth Court, however, reversed. The court held that the employer was not collaterally estopped from contesting causation of the claimant's psychiatric condition by not challenging the UR Determination, finding that treatment to be reasonable and necessary. Moreover, the Commonwealth Court agreed with the employer that the filing of a UR Request on the psychiatric treatment did not constitute an admission that the claimant's anxiety and depression were causally related to the acknowledged work injury.

Case Law Alert, 3rd Qtr 2011