If you sustain an injury while working, you’re entitled to file a claim against your employer’s workers comp insurance to cover treatment. In the acute phase of the injury, you may have hospital and doctor bills, lost wages from missing work, and other associated costs. In the long term, depending on the type of injury, you may need to pursue a larger claim that covers future costs for things like physical therapy, pain, and suffering, etc. What do you do, however, if you receive notice that you’ve been denied medical treatment? Your claim could be totally denied, or, if accepted, the insurance company’s doctors could deny treatment.
Unfortunately, this happens all too often, and many people don’t pursue the matter further. Insurance companies now hire doctors to review and often deny medical care and prescriptions your treating doctor wants you to have. They. of course. do what they’re paid to do — deny care whenever they can. We recommend that you do not give up your rights just because your claim is initially declined or because your doctor’s treatment or prescription is denied. Contact Gold Country Workers Comp Center and schedule a free consultation with an attorney who can help you navigate the system and ensure that you receive the compensation you deserve.
Getting authorization
Assuming you’re not in immediate danger for your life, the first step, when you’re injured at work, is to notify your employer of the incident, at which point you’ll be asked to fill out authorization forms. (If your employer does not offer these forms to you, or if you are worried about how your employer will react to your request for the forms, you should consult with an attorney who specializes in Workers’ Compensation to provide them to you and advise you on how best to proceed.)
These documents notify the insurance company regarding your injuries and intent to pursue medical treatment. There is standard State of California forms that you’ll be required to fill out. Don’t be surprised, though, if you experience a delay in getting approved for medical treatment.
Should you have questions or concerns about the process, ask your workers comp attorney to advise you on your rights as well as the expectations of the insurance company. For example, in many workers comp cases, the insurer will require that you be seen by a doctor that is approved by them even if you’ve already seen a physician of your own choosing.
The review process
The bottom line is that being denied medical treatment does not mean that you don’t have a legitimate claim OR that you don’t have access to medical care through other programs. In addition, if you’re not in agreement with the insurance company on the course of treatment that is authorized by their physician, you can ask for an independent medical review.
Unfortunately, the statistics show that, once a treatment or prescription is denied by the insurance company’s doctor, the review process will UPHOLD the denial in about 85% of the reviews (vs. about 30% of appeals in those rare cases where treatment or a prescription is denied at the initial review stage ny private insurance companies).
A Workers’ Compensation specialist can make a real difference in getting you the medical care you need through the system. Call Gold Country Workers Comp Center today to speak with an attorney for workers comp cases who can make sure your best interests are represented and that you receive proper care and financial compensation after your injury.
The system is very complicated, and initial consultations are free. It costs no more to get an attorney involved early on in a case compared to later in the proceedings. If you encounter resistance from the insurance company, an attorney can help keep the case on track and settled or tried for maximum value.
