Workers compensation insurance companies and employers may deny medical treatment for a variety of reasons including:
• The treatment is not related to the work injury.
• The treatment is outside of the allowed treatment parameters.
• The chiropractic treatment is beyond the 12 weeks of allowed care without an allowed departure.
• The treatment is not reasonable and/or necessary.
These are just some of the reasons that an adjuster or claims representative may deny treatment. They are required under the law within 7 days to either admit, deny or request a second opinion such as through an independent medical examination. In the cases of surgery, they are obligated to have an independent medical examination within 45 days of the request for surgery.
So what do I do if I am not getting the treatment I need approved?
In most cases, it may be beneficial for you to sit down with a work injury lawyer to discuss your legal options and whether or not a claim would need to be filed to get the treatment approved. There are, however, things that you can do on your own without the assistance of a lawyer to help you get the necessary treatment, including:
• Make sure that your provider has submitted the appropriate forms or bills to the insurance company.
• Contact the insurance company to confirm that they have the appropriate information from the medical provider.
• Determine whether or not an independent medical examination has been scheduled. If an adjuster is dragging their feet in scheduling one, it may be in your best interest to contact the Department of Labor and Industry to assist in getting the examination scheduled so a determination can be made. They can be reached on the Workers’ Compensation hotline.
If any of the above is unsuccessful or if you have already been told that the treatment is denied, you should contact a workers’ compensation lawyer in order to discuss your case. The lawyer will need to gather all of the appropriate documents including bills and medical records and file either a Medical Request or Claim Petition on your behalf. The attorney will also need to make sure that the appropriate medical support is gathered, including an opinion as to why the recommended treatment is reasonable, necessary and causally related to the work injury.
This can devastating as often times the denials occur at a pivotal point when treatment is necessary to get you back on your feet and doing the things you used to do. An experienced workers’ compensation lawyer should be able to help you and guide you to make good informed decisions.
We are experienced workers’ compensation lawyers willing to meet with you for a free. If you would like to discuss your case, please feel free to contact Mottaz & Sisk today.