For a no cost consultation with Maryland workers compensation attorney Andrew Rodabaugh call +1 (410) 937-1659
As discussed in Series 1 of this post the confusion among workers injured in Maryland often starts with the setting up the very first doctors appointment. If the injured worker is able to get to a doctor without any issues or confusion, or if they understand the process of requesting for and obtaining authorization then the confusion may come at a later date.
I often see the confusion set in once the doctor indicates that a particular treatment be obtained. This could be in the form of physical therapy, injections, surgery or even diagnostic tests. The hurt worker then receives the phone call from one of the treating providers and it is indicated that the treatment has not been approved or authorized and the treatment is denied. Those injured Maryland workers that are new to the workers compensation process are puzzled by this phone call. It is not like the usual practice when using health insurance. Again the injured workers treatment is being carefully scrutinized by the workman’s comp adjuster because there is more exposure to expenses for the workers compensation adjuster. Health insurer’s only have to deal with paying for medical treatment. Workers Compensation adjusters have to consider all of the benefits to which a worker injured in Maryland may be entitled.
The phone call from the Doctor’s office could mean a few different scenario’s are arising.
As stated the adjuster may be attempting to control the costs of the claim. By denying the appointment the injured worker has to either fight for the treatment and possibly lose, or carry on with their life and give up on obtaining treatment through the Maryland workers compensation carrier. All to often the injured worker does the latter, returns to their daily life, and goes without treatment they need and to which they are entitled. The adjuster and insurance company save money in the latter scenario. In the former scenario, the injured worker decides to fight. The injured worker may lose in which case the adjuster still saves the money, but in many cases the injured worker gets the treatment, gets compensation, and gets the benefits Maryland workers compensation laws are designed to provide.
If the worker injured decides to fight it out with the adjuster they will need to hire a Maryland workers compensation attorney that is experienced and qualified enough to get the benefits. The adjuster will have an attorney on retainer ready to represent them during the claim. The injured worker must put themselves on a level playing field.
The workers compensation case worker simply did not “get around” to providing the authorization to the doctor or facility that is going to perform the treatment. Again, unlike health insurance adjusters, workers compensation adjusters must consider factors other than medical treatment. For some injured workers this may seem harmless, but it could indicate what is to come in the future. Workers compensation adjuster are largely overworked and very often do not have the necessary time to dedicate to each and every injured worker. For the worker this means less than adequate response time on almost every attempt at contact. It can indicate ongoing delays in treatment, prolonged absence from work, and worsening of condition.
In some circumstances there was simply a oversight on the adjusters part and the treatment that is recommended is approved. If that is the case then the injured Maryland worker may not be confused at all and grasp exactly what is going on. However there may come a time when follow up treatment or settlement money is not offered. Perhaps an Independent Medical Evaluation is scheduled before further treatment is approved.