When you are hurt on the job, you can attain a number of benefits under the Workers’ Compensation Act. In addition to receiving payments for time spent off work, you have the right to medical treatment from the doctor of your choice and the right to a settlement for any permanent injury you sustain. To receive medical treatment under workers’ compensation, you have to prove to the insurance company that the injury was worked-related. An insurance company is entitled to investigate the claim before they begin paying benefits.
Finding approval for medical treatment in Oak Lawn workers’ compensation can be more difficult than it appears. You could benefit from first talking to a skilled workers’ compensation attorney who knows their way around these requests.
It is common for an employer to send an injured worker to a nearby occupational medical clinic, such as Concentra or MercyWorks. When an employer does this, that facility typically does not have the worker’s best medical interest in mind. The job of the company doctor is to return that person to work as quickly as possible with as little medical treatment as possible. Under the Workers’ Compensation Act, employees are not required to go to the company doctor and many lawyers advise against it. This choice of doctor does not include initial emergency treatment.
In addition to the doctor of their choice, the worker has the right to treat with any medical facility or physician for which their preferred doctor writes a referral. This is called the chain of medical treatment. If the doctor refers them to physical therapy, for an MRI, or to a specialist, workers’ compensation insurance is responsible for paying for these charges.
No one has to rely solely on the company-aligned doctor to receive approval for medical treatment in an Oak Lawn workers’ comp case.
There are two main reasons why workers’ compensation insurance might deny payment for someone’s medical treatment: if a proposed treatment is not certified or if an independent medical exam recommends against it.
In a Utilization Review (UR), the insurance company is allowed to review proposed medical treatment for medical reasonableness. A proposed treatment will be either certified or non-certified based on certain guidelines. An insurance company cannot deny treatment simply because they do not want to pay for it – there must be a written guideline which excludes the treatment. If treatment is denied by UR, the treatment can often be approved after an appeal from a doctor.
The second potential reason why an insurance company might deny authorization for medical treatment is following an Independent Medical Exam (IME). An insurer has the right to send a worker to a doctor of their choice, not for treatment but for an evaluation of the cause of the injury, as well as the necessity of the treatment. If that doctor states that the injury is unrelated or that the worker has reached maximum medical improvement (MMI), insurance can refuse to authorize additional treatment. This will cause the temporary total disability payments to stop and will result in denial of future medical care.
There are a few alternatives when an insurance company refuses to authorize or approve medical treatment. First, if the worker has group health insurance or another method to pay for medical care, it is often advisable to get treatment that way. Second, they could go before the Workers’ Compensation Commission and have a hearing before an arbitrator to force the insurance company to provide medical care. It is advisable to discuss the likelihood of success with a lawyer before requesting a hearing to approve medical treatment.
Lawyers are happy to work with an injured worker’s preferred doctor or refer them to the best area doctors to care for that specific injury. Even if workers’ compensation insurance has approved local medical treatment, it is still a good idea to work with a lawyer. Some people wait to contact a lawyer until after the insurance company has stopped authorizing treatment. It may be more difficult to reinstate lapsed medical treatment than it would have been for legal counsel to get continued treatment approved.
There are multiple parties whose self-interest is for you to receive as little help as possible after an accident. A lawyer could get you help in approving medical treatment in an Oak Lawn workers’ compensation case. Call now to talk with one about your situation.