This scenario happens in many, many workers’ compensation cases: you go to the doctor, he or she recommends medical treatment, you talk to the insurance company, and the company says it will not cover the treatment. Sometimes people get the treatment first and have it billed to the insurance company before finding out the company will not agree to pay.
Challenge the Denial of Treatment
If your doctor recommends that you receive this treatment, you need to challenge the insurance company’s denial. If you have a lawyer, tell your lawyer that you need the treatment. He or she can talk to the insurance company representatives and try to reach an agreement.
Often, the insurance company denies a treatment request because it simply does not have enough information about why you need it. You need to show that the treatment is reasonable and necessary to treat your workplace injury, and sometimes that your injury was work-related in the first place. The insurance company needs to see medical support for your claim. This could include:
- A report or letter from your doctor
- Medical records
- X-rays or test results
Talk to your doctor about gathering the necessary medical support. If you are struggling to get information from your doctor, or if he or she is not familiar with the workers’ comp system, you may want to change doctors.
Reasons Treatment May Be Denied
The insurance company may deny treatment for a variety of reasons. As mentioned above, the insurer may not believe that the treatment is reasonable and necessary, related to your work injury, or supported by medical evidence. In addition, the insurer may say that it has been too long since your work injury and question why you suddenly need treatment now. You should make sure it has your up-to-date medical records. Also, you may have gone back to work for a different employer since the injury. The insurer may question if you got injured again at the new employer. Or the insurer may argue that a settlement in your case released your right to future medical care.
Whichever reason the insurance company gives, it is important to challenge the denial to get treatment you need. Speak to a lawyer as soon as possible if you need assistance with your workers’ compensation case.
Need help getting workers’ compensation for your injury? Joe Osterbauer, Esq. and the Osterbauer Law Firm stand up for injured Minnesota workers’ rights. Joe’s 27 years of workers’ compensation experience and his team’s speedy service combine to get clients the results they need. To schedule a free consultation, visit Osterbauer Law Firm online or call Joe’s office at (612) 334-3434.