It usually isn’t hard to get workers’ compensation insurance to pay for routine medical check-ups and visits related to your injuries.
A worker may also obtain emergency care without fear of insurance denial in most cases. Authorization is presumed in life-threatening situations.
Too bad most workers’ compensation cases involve extensive, often catastrophic injuries. Those injuries often require expensive tests and treatments like:
- CT scans
- Specialist care
- Physical therapy
- Expensive medications
It is often much, much harder to get workers’ compensation insurance to pay for these treatments.
Often, obtaining these treatments means getting those treatments authorized in advance. Often, obtaining authorization is your doctor’s job, but you will still receive notice if the insurance company denies your initial authorization.
The company may deny the treatment, even in the authorization phase, because:
- They disagree that the treatment is “medically necessary,” even if it clearly is.
- They want you to use a cheaper treatment.
- They are hoping to frustrate you until you give up.
- They are claiming some administrative problems, such as a failure to meet certain deadlines.
- They want to claim that the new treatment has nothing to do with your work-related injury.
- The employer’s doctor doesn’t think you need the treatment, but your own second-opinion doctor does. Obviously, the workers’ compensation insurance company wants to use the doctor’s opinion that favors them, even if that doctor ignores your health and needs.
- A human didn’t even look at your claim; an AI-bot or algorithm denied your claim instead, and the human on the other end of the phone or letter is happy to dig in their heels and accept the robot’s opinion.
Fortunately, you have recourse if your insurer refuses to authorize medical treatment. Your workers’ compensation lawyer can file a request for a hearing after gathering evidence that you require the care that is being requested. We may also file a Claim Petition on your behalf. It is possible to challenge denied claims, but you’ll get farther when you have a lawyer on your side. Insurance companies often feel free to ignore the injured worker, who they perceive as having very little power.
Be sure to document the progression of your injury or illness and note all the problems you face, both major and minor. The more documentation you provide, the stronger your case will be when it’s time to dispute a claim.
Are you struggling to obtain authorization for medically necessary treatments? If so, contact Talone Law for help with your workers’ compensation claim.