Which Medical Care Will the Insurance Company Approve?
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Which Medical Care Will the Insurance Company Approve?

Workers seeking medical care for their work-related injuries should know that the employer’s insurance company reviews every charge. If the company does not approve a charge, the worker will have to pay out of pocket or fight the disputed charges. Unfortunately, insurance companies often make it unnecessarily difficult for injured workers to get the care they need.

Under Minnesota law, an injured worker may receive medical care and supplies that are “reasonable and necessary” to treat, cure, or relieve the work-related injury. Medical care may include surgery, a hospital stay, psychological services, medication, or other services depending on the injury. Medical supplies may include a wheelchair, hearing aids, dentures, or many other types of supplies, again depending on the injury.

In addition, the insurance company must pay reasonable expenses incurred by the employee in seeking medical care, such as mileage, parking fees, and document copying costs. To reimburse medical care costs and reasonable expenses, the insurer must receive documentation of these costs and expenses either from the employee or the medical providers.

The term “reasonable and necessary” medical care is extremely vague. Minnesota law lists a few reasons why a charge for care or supplies might be termed “excessive” and thus not compensable by the insurer. First, the charge could reflect care lasting an unnecessarily long time, occurring too frequently, or being at a level above accepted medical standards. Second, the charge could reflect inappropriate or excessive care or supplies. Third, the charge could reflect services outside the usual practice of the medical provider. Fourth, the charge could reflect services not generally accepted as being of therapeutic value for the injury. Fifth, the charge could exceed the maximum amount for that service on the fee schedule.

Minnesota has a medical fee schedule listing the maximum amounts that a workers’ compensation insurer has to pay for reasonable and necessary medical services. If a medical provider’s usual fees exceed the fee schedule amounts, the charge to the insurer is capped at the fee schedule maximum. If a medical provider’s usual fees are lower than the fee schedule amounts, then the insurer pays the usual fees.

Were your workers’ compensation medical charges disputed by the insurance company? 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.