Imagine experiencing a work-related injury only to have your workers’ compensation claim for medical care denied, or worse, workers’ compensation denies medical care. The pain, stress, and financial burden can feel overwhelming. But don’t lose hope.
You can work with an experienced workers’ compensation attorney to determine the reasons behind workers’ comp denials and discuss strategies for challenging a denied medical care claim. Contact a Grand Rapids workers’ comp lawyer as soon as possible for a free consultation concerning your case.
What Medical Care Should Workers’ Comp Cover?
According to Michigan’s Department of Labor and Economic Opportunity, workers’ comp should pay for all of an eligible employee’s reasonable and necessary medical care. Additionally, the bills related to your work injury should be sent directly to your employer – or his or her insurance carrier.
Costs covered by workers’ comp medical benefits may include:
- Emergency transportation
- Surgeries that may be required to aid in a worker’s recovery
- Medical appointments and examinations related to the injury
- Diagnostic testing, such as MRIs or X-rays that may be needed
- Hospital stays after surgery or other related treatments
- Pharmaceutical needs, such as prescription medications
- Dental services that are related to the work injury
- Chiropractic care
- Crutches, wheelchairs, and other mobility devices
- Physical therapy
What if Workers’ Comp Refuses to Pay for the Care I Need?
It is not uncommon for employers and/or their insurance carriers to initially deny payment for certain medical costs for an injured worker. For example, say that you have a back injury that was reinjured on the job. The insurance carrier may refuse to pay for the treatment you need, saying the injury was preexisting. However, it can happen later on in your recovery as well.
Regardless of when your insurance carrier denied payment for your treatment, you may still have legal options for continuing your care. Some steps you can take to overturn the insurance carrier’s decision include:
- Contacting your insurance carrier and asking them to send you a written explanation as to why the payment was denied (if not included in the notice you received)
- Filing a dispute by submitting an Application for Mediation or Hearing form
- Continuing your medical care – while your claim is in dispute, you can submit your medical bills to your health insurance carrier
- Saving the invoices, receipts, and costs related to the medical care for your work injury
- Carefully – and regularly – documenting the progress of your injuries
- Proactively discussing your injuries with your doctor
- Contacting a qualified workers’ compensation lawyer for legal help
Navigating the complex world of workers’ compensation can be challenging, especially when faced with a denied claim for medical treatment. Denials often stem from disputes over the necessity of treatment, pre-existing conditions, or unauthorized providers. The impact on injured workers can be significant, as they struggle to cover medical bills and lost wages while recovering from a work-related injury.
Understanding the reasons behind workers’ comp denials is crucial for injured workers seeking to challenge these decisions. Employers and insurance companies may question the necessity of certain treatments or argue that an injury is unrelated to work or even self-inflicted. Furthermore, using unauthorized medical providers can lead to denied workers’ comp claims. By recognizing these potential pitfalls, injured workers can better navigate the workers’ compensation system and pursue a successful claim.
Why Did Workers’ Comp Deny Payment for My Medical Treatment?
Workers’ compensation should pay for all medical costs that are related to your work injury and are also both reasonable and necessary. However, even if your treating physician recommends certain medical care, the insurance carrier may disagree. They could refuse to pay for that treatment if they determine:
- The treatment is not deemed as either reasonable or necessary: Your insurer may argue that other treatments – cheaper or less invasive – could have been tried first.
- You have failed to follow your doctor’s orders: Consistently missing doctor’s appointments or failing to adhere to his or her care recommendations.
- Your injury or medical condition was preexisting: Commonly, insurers may try to argue that if your injury was preexisting, it could not be work-related.
- You have reached maximum medical improvement (MMI): Your insurer will likely deny payment for continued medical care if they determine you have reached your MMI.
Insurance carriers often try to get out of paying for medical costs. They may hope that once they deny your claim you will just give up trying to get your medical bills paid.
Strategies for Challenging Denied Medical Care
When faced with a denied workers’ comp claim, it’s essential to explore various approaches to challenge the decision. Collecting relevant medical records and documentation to support the need for denied medical care is a crucial first step.
With the necessary evidence in hand, injured workers can explore several strategies to contest the denial. This may include filing an appeal with the insurance company, requesting a hearing with the state workers.
Requesting an Independent Medical Examination
One effective strategy is requesting an independent medical examination (IME). An IME is a medical evaluation conducted by a healthcare professional who was not previously involved in the patient’s care. This impartial assessment can help determine the severity of an injury or disability and provide crucial evidence to contest a refusal of medical treatment.
IMEs can be requested by the patient, their attorney, or their insurance company. The IM.
Filing an Appeal
Another option is to file a workers’ compensation claim and, if needed, an appeal with the workers’ compensation board. This legal process involves submitting a written appeal, requesting an independent medical evaluation, and attending a hearing. To strengthen your claim, it’s essential to collect the necessary evidence, such as medical records, reports, and other documents that validate your claim.
Engaging a workers’ compensation lawyer during a hearing can provide significant benefits. They can help strengthen your claim, provide clarity on any denials, and create a more equitable situation if the employer is represented by legal counsel. With their expertise, injured workers can increase their chances of a successful appeal.
Seeking Legal Assistance
Enlisting the help of a workers’ compensation attorney can be a game-changer. They can assist with navigating the appeals process, advocating for medical benefits, and offering advice on maximizing medical benefits through alternative coverage options.
Don’t hesitate to seek legal assistance, as it can significantly impact the outcome of your workers’ compensation case.
Is Workers’ Comp Refusing to Pay For Medical Care You Need?
At Jay Trucks, we understand how important it is for you to get the medical treatment you need after suffering a work-related injury. Our qualified attorneys have been handling workers’ comp cases for decades. We have recovered millions for our clients, including $480,000 for a pipefitter who suffered a severe close head injury in a work accident.
Get legal help you can trust when you call our firm. We are available to take your call 24/7, but deadlines may apply, so call today. If we find you have a case and you hire our services, there is nothing to pay up front. We do not get paid unless we recover compensation for you.
Speak to a Lawyer Today. (800) 762-8623