When you suffer an injury on the job, workers’ compensation insurance steps in and pays 2/3 of your wages and 100% of your injury related medical care.
Sometimes, however, workers’ compensation insurance, in an effort to minimize its financial responsibility for your injuries, may stop treatment. Perhaps your doctor files a recommendation for a certain treatment and that treatment is denied by your insurance. The insurer may deny the care, ignore the request, or order an Independent Medical Exam.
What should you do?
Step One: Consult an Attorney
Under Minnesota law, you have the right for workers’ compensation insurance to pay for any medical treatment you need for your injuries. In general, workers’ compensation benefits continue throughout your recovery, and you have the right to the full medical treatment that is reasonable, necessary, and causally related to your injury.
In some cases, however, workers’ compensation can legitimately deny further medical benefits. This includes:
- Hiring a private investigator who discovers you exaggerated the impact of your injuries
- Obtaining an opinion from their own doctor justifying their denial of care for a variety of reasons such as the care is not reasonable or related to the injury.
Talk with an attorney to discuss why your insurance company has decided to stop treatment and what you might need to do next.
Step Two: Talk with the Insurance Company
Your insurance company may not always deny needed treatment out of malice. Sometimes, this may be due to an error in filing or paperwork: an incorrect assessment of your injuries in the company database, for example, or a treatment request with the wrong code. Sometimes, however, you may not receive a clear explanation about why the treatment was denied, especially if it comes through an automated system. By talking with the insurance company, especially if you go through your lawyer, you can often get a better answer about why treatment was denied and what you need to do to continue treatment. If you choose to retain an attorney, then let your attorney contact the insurer.
If you believe that the insurance company has unfairly stopped treatment for your injuries sustained on the job, working with an attorney can help you deal with the insurance company and increase the odds that the company will approve needed treatment. While you wait, continue doing your part to aid in your recovery. Take particular care with activities that could worsen your injuries, and try to complete needed therapies. Follow the advice of your attorney and your doctors to the best of your ability to help increase the odds that your insurance company will then approve treatment.
Step Three: Request a Hearing
If you, or your attorney, and the insurance company cannot resolve the issue, you can request a hearing or a medical conference to have the issue decided. It is best to have an attorney when taking this step. You will also need any records or medical bills related to the unpaid bills or care you are seeking.
If the insurance company denies or stops care, often you need a workers’ compensation attorney to advise you on your options and to get care continued. Contact us today to learn more about how we can help.