Injured workers ask this question on a daily basis. What might surprise you is that many workers’ compensation doctors ask themselves the same question concerning their patients. The legislature has implemented laws that often provide a road block to medical treatment. Denials of medical treatment force limitations on doctor’s treatment plans. It is wise to ask for help in dealing with denials of medical treatment before it is too late!
As indicated in previous blogs, Utilization Review (UR) and Independent Medical Review (IMR) have made obtaining medical treatment much more difficult for workers. UR treatment denial decisions are made by insurance company hired doctors/practitioners. Unless that denial is untimely, the denial must be appealed through the IMR process. This process often takes up to 3 months to obtain an IMR final decision. More delay! The last statistics I heard at a recent convention were about 84% of IMR final decisions continued to deny the medical treatment. Thus, merely 16% of IMR decisions overturned denials and provided authorization for the treatment.
One must be prepared to deal with a treatment denial. A Primary Treating Physician (PTP) willing to fight for your treatment is very important. An injured worker has the right to choose their PTP with certain limitations. There are many time constraints in dealing with treatment requests and denials. Moving denied treatment through IMR requires a significant amount of work including applications, correspondence and providing appropriate medical records/documents to the IMR reviewer. There are many pitfalls for the unwary.
Contact Timmons, Owen, Jansen & Tichy, Inc. for a free consultation and let us take the burden of the workers’ compensation red tape off your shoulders!
