In: Workers' Compensation

What Happens When an Insurance Company Objects to Your Medical Treatment?

 

Dedicated Attorneys in Missouri Helping Clients Throughout the Workers’ Compensation Process

Filing a workers’ compensation claim is the best way to recover compensation for your injuries after you have suffered an on-the-job injury in Missouri. While workers who are injured at work and follow the steps for recovering compensation (i.e. reporting the accident within the required amount of time, seeking medical care, etc.), are almost always authorized by the workers’ compensation insurer to get the medical treatment they need, sometimes, an insurance company objects to medical care.

If your workers’ compensation insurer has objected to medical treatment that you and your healthcare provider believe you need, it is important that you understand what steps to take next.

 

Determine the Reason for the Objection

If your insurance company discontinues your medical treatment, or outright refuses to provide medical treatment, it is important that you understand why. Some common reasons include that your case is being denied (i.e. your employer disputes that your injuries are valid or occurred on the job), your employer/insurer believe that you have improved to the point where you no longer need care and can perhaps even return to work, or the insurer feels that you are not complying with the medical care that you are seeking by not following doctors’ directions, not attending appointments, etc.

You should absolutely ask the insurance company to give you a written explanation as to why they have objected to your medical treatment. From there, you can take the next steps.

 

Independent Medical Examinations

Sometimes, the fact that your insurance company has denied your medical care is a misunderstanding or an error, and simply discussing the problem can remedy it. If you and your insurer are unable to come to an agreement, however, the next step may be undergoing an independent medical examination (IME). During an IME, an impartial doctor will assess you and provide a second opinion about your condition and the treatment that you need.

 

Filing an Appeal

If the results of an IME are not enough to get you the treatment that you believe you need, you may need to:

  • Engage dispute management services;
  • Request a conference before an administrative law judge; or
  • File a claim for compensation and hire an experienced attorney (if you have not done so already).

A conference before an administrative law judge allows all parties to talk about the case, and reach a settlement. If this is not effective, then you may need to request a hardship hearing, in which you will claim that you have not reached your maximum medical improvement and still need treatment/benefits as such. If the judge does not side with you, you are allowed to appeal the decision with the Labor and Industrial Relations Commission.

 

Working with an Experienced Missouri Workers’ Compensation Attorney

Being denied the treatment you believe you need and are entitled to can be very frustrating and emotional. At the law offices of Morrison, Webster & Carlton, our hard working Missouri workers’ compensation attorney can represent you if you are dealing with a claim denial. To learn more, schedule a free consultation with our law offices today.