Workers’ Compensation Keeps Denying Medical Treatment
What happens when your case is accepted, but your medical treatment is denied?
When you are injured at work, you may receive several benefits under workers’ compensation. Medical treatment is an obvious and necessary benefit under workers’ compensation. When you are in pain, you deserve what it takes to restore you to your usual health.
In an ideal world, you get what your doctor recommends. However, in workers’ compensation, it is not just the doctor who decides. The insurance company is also involved. Your doctor may recommend treatment that is denied by the insurance company. And it is the employer’s insurance company who pays for all treatment. All too often the insurance company’s goal is to protect their bottom line and that means you get as little treatment as possible.
So what happens when your case is accepted, but your medical treatment is denied?
Understanding the Denial Process
When your injury claim is accepted, you get a doctor for your medical appointments. You attend your appointments where your doctor recommends what treatment you need. Here is what happens after you leave your appointment:
· Your doctor writes a report and attaches a “Request for Authorization” form with the recommended treatment. The doctor sends that form to the insurance company.
· The treatment request is reviewed by insurance company doctors to see if the request is appropriate under medical guidelines. When the insurance company doctors decide it is not appropriate, they issue a denial notice explaining why.
· The denial notice must attach an application for Independent Medical Review. By law, Independent Medical Review is how you appeal a denial of treatment. Independent Medical Review provides the parties to submit the decision to another doctor and provide that doctor with supporting documents. It is a process that can take up to two months to return a decision.
Issues with Independent Medical Review
In a study of145,702 Independent Medical Review applications from 2021, it was found that 92.8% upheld the insurance company’s denial. When treatment is further denied, that only delays your improvement, ability to return to work, and settle your claim. If Independent Medical Review is the only way to appeal the insurance company’s denial, does that mean the workers’ compensation system won’t provide you with help?
An Attorney at SoCal Workers Comp Can Help with Insurance Company Denials
You have the right to an attorney to help with your workers’ compensation claim. The attorneys at SoCal Workers Comp are experienced with the Independent Medical Review process and can offer solutions. When you hire an attorney at SoCal Workers Comp, you get the following:
· Case management attention to your doctor’s treatment requests. If the insurance company takes too long to deny the doctor’s request or fails to deny at all, your attorney can request a workers’ compensation judge to make the decision.
· Records retrieval to gather and organize your medical records. These records will be submitted to Independent Medical Review so the appeal has all necessary information to help obtain a better outcome for you.
· Legal review of the Independent Medical Review decision to determine if any legal errors were committed if the decision upholds the insurance company’s denial. If any errors are found, your attorney may have the option to file a petition setting aside the decision.
· Consultation for next steps. Your attorney may have alternative proposals to help get you the treatment you need. The attorneys at SoCal Workers Comp develop relationships with doctors by communicating Independent Medical Review issues to help with future reports.
Get a Free Consultation Today
You do not have to deal with insurance company denials on your own. Hiring an attorney at SoCal Workers Comp costs nothing up front. We only get paid if we win your case at trial or in settlement. And a consultation with us is free. Call or schedule for one today.