One of the best things about workers compensation is that it covers medical treatment you need to recover from your injury. But, one of the most frustrating things about workers compensation is when insurance company’s do not approve the medical treatment your doctor says you need.
I speak with too many people who have been waiting weeks or months to get the medical treatment they need. This delay causes several problems:
- You have more pain than you should have
- You cannot do the things you enjoy doing outside of work.
- Your life is put on hold
- Sometimes, the delay may even cause your injury to get worse.
Fortunately, there are some steps you can take to get your workers compensation medical treatment faster.
What Can You Do to Get the Medical Treatment You Need?
There are two main ways that the workers compensation insurance company slows down your medical treatment:
- Failing to approve your medical treatment
- Denying your medical treatment
You have several options for dealing with these insurance company delay tactics. The best approach to take will depend on which tactic the insurance company uses as well as the specific facts of your case.
Get the adjuster to approve the medical treatment
One option that you or an attorney representing you can take is to talk to the insurance adjuster and get the treatment approved. The adjuster is the person with the insurance company that has the power to make decisions in your case.
If the adjuster communicates to the doctor’s office that your medical treatment is approved, that generally solves the problem and you will be able to get the medical treatment. Communicating with the adjuster can sometimes make that happen.
The difficult thing about this approach can be getting in touch with the adjuster. Sometimes, you cannot get the adjuster on the phone to have a conversation about getting medical treatment approved.
There are some tricks that are helpful in overcoming this problem. Emailing some adjusters works. Also, it sometimes help to try to communicate with someone else in the insurance company’s office to get an answer.
What can be done if communicating with the adjuster does not work?
Often, trying to communicate with the adjuster may not fix the problem. There are other things that can be done to make sure you get the medical treatment you need.
Often, what I will do in a case is to file a document known as a Form WC-PMT. The PMT is short for Petition for Medical Treatment. The State Board of Workers’ Compensation created this form to address delays with medical treatment approval.
Filing the form requests that the insurance company file a written response approving or denying the requested medical treatment. If the insurance company does not respond, a phone call takes place with a workers compensation judge. After the phone call, the judge can order approval of the treatment.
Are there other methods for getting treatment approved?
The Form WC-PMT can be a great tool for getting treatment approved. But, the State Board’s rules require that attorneys follow certain procedures to file this form. Also, the form cannot be used in all medical treatment denial situations.
Fortunately, there are other ways to get treatment approved. One of the most common methods is a hearing in front of a workers compensation judge.
The State Board also has a form to request hearings. It is a Form WC-14. Using this document can allow you or an attorney representing you to request a hearing in front of a workers compensation judge.
Just like there are rules and procedures when filing a Form WC-PMT, there are also rules and procedures about requesting a hearing. More importantly, there are many different rules about how you can use the discovery process to obtain evidence once a hearing has been requested and how your evidence has to be presented to a judge.
You do not have to have an attorney to request or move forward with a hearing. But, the workers compensation insurance company will have an attorney representing them who specializes in workers compensation. Many people who try to proceed to a hearing without an attorney representing them end up losing their case because they do not understand all the rules associated with gathering evidence before a hearing and presenting it at a hearing.
Before you move forward with requesting a hearing in your case, talk to a workers compensation attorney to find out if that is the best option for you and whether you should get an attorney involved to go that route. Our firm provides free consultations in workers compensation cases.