Why Won’t the Insurance Company Pay for the Treatment You Need?
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Why Won’t the Insurance Company Pay for the Treatment You Need?

Getting a denial of benefits from the workers’ compensation insurance company hurts – often literally. The insurer is refusing to pay for treatment that you need to heal from your workplace injury. If your health insurance will not cover it, you could pay thousands of dollars out of pocket.

You are not alone in this stressful situation. It is extremely common to receive a benefits denial at some point during a workers’ compensation case. The possibility of paying less money to injured workers motivates insurance companies to deny treatments that they feel are unnecessary. There are a variety of reasons the insurance company may have denied benefits in your case:

  • Its representatives think the treatment recommended by your doctor is not necessary
  • The treatment is not usually recommended for someone with your injuries
  • Its representatives think you do not have an injury that makes you eligible for workers’ compensation
  • They think the treatment will only help an older non-work injury, not the current one
  • They think there are less expensive or less invasive treatment options that you should try first

To figure out which reason, look at either the Notice of Insurer’s Primary Liability Determination or the other paperwork you have received related to the treatment you are receiving. They may have sections explaining why the insurer will not cover certain treatments. Some of these documents explain how to appeal a decision to deny treatment. Often, you will need to file a Claim Petition.

A Claim Petition challenges the benefits denial through the Minnesota Department of Labor and Industry. It is not the same thing as filing a lawsuit, but if you file a petition you will have a hearing in front of a judge to show why you should get benefits. Before the hearing, your lawyer will exchange documents with the insurance company, and you may need to attend a medical exam (IME). And yes, you should look for a lawyer if you want to file a Claim Petition. Your lawyer will help you navigate the legal process and represent you at the hearing.

After you file a Claim Petition, you will see that an initial denial of medical benefits is not the end of the road for workers’ compensation. You have to stand up for your right to receive benefits every step of the way.

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.