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WORKERS COMP- DENIED and DELAYED MEDICAL TREATMENT

Was your medical treatment denied by workers comp?

Are you receiving slow medical treatment in your workers comp case? 

Is both health insurance and workers comp refusing to pay for medical treatment in workers comp case?

Workers Compensation Attorney Andrew M. Rodabaugh Esq. has been getting medical treatment authorized for injured workers for years!  The process is frustrating but with an attorney it can be made easier.

Speak with Baltimore workers compensation lawyer Andrew M. Rodabaugh for a FREE consultation   Call Click to email  or just fill out the form below and Mr. Rodabaugh will contact you!

workers comp medical treatment

TBIT / Pixabay

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Has the Maryland workers comp adjuster terminated your treatment or are they refusing to provide authorization?  Did they deny an MRI or surgery?  Perhaps even a doctors visit was denied.

Sometimes your case starts off just fine and treatment is not denied by workers comp!  Regularly, the workers compensation process starts off very easy for the workers comp recipients.  The worker is injured at work and is sent by the employer to a medical clinic for treatment.  The clinic may be one such as WorkMed, Concentra, or Patient First.  Treatment is provided in the form of medication, x-rays, and possibly some physical therapy.  Everything seems to be smooth sailing while treatment is obtained however out of know where workers comp denies medical treatment.  This most often comes at a very unexpected time and, to the  injured worker it seems very confusing.

If you have received an Independent Medical Evaluation (IME) notice then there are things you should know before attending. 

Understand why your medical treatment was denied by workers comp

The short answer- treatment is getting too expensive or your case is too serious for the workers compensation adjuster to simply continue paying for the medical treatment so medical treatment was denied by workers comp.  The theory and goal of the workers comp adjuster is to provide minimal treatment and hope that the worker returns to work without seeking a Maryland workers compensation attorney and without seeking all the benefits to which law provides.  Most likely medical treatment was denied by workers comp at the point where the case is becoming increasing costly or is about to become costly.

One common point when the workers compensation adjuster will deny medical treatment is if a Magnetic Resonance Imaging (MRI) is prescribed.  The reasoning is that the MRI may help determine what needs to be fixed.  X-rays will show if any bones are fractured and are relatively inexpensive so these are most often approved by the adjuster with no problem.  MRI’s on the other hand cost much more than x-rays and will diagnose soft tissue damage, ligament tears, muscle tears, blood issues, and much more. The MRI medical treatment was denied by workers comp because they may have to pay to fix any torn ligaments or soft tissue damage.  Once a condition is discovered the Maryland workers comp insurance company will have increased financial exposure.  If no condition is discovered then they save money.

Another common milestone that explains why medical treatment was denied by workers comp is when surgery is being recommended.  Not only is surgery expensive, but lost wages, further therapy, medication, and complications can increase the cost of the claim exponentially.  Further, once a surgery is performed on an injured worker the need for future treatment is substantiated which means workers comp could be on the hook for years to come.

Understand what you can do if medical treatment was denied by workers comp

If this is the situation you are faced with then you may be quite frustrated and it is probably time to seek counsel with an experienced  Baltimore Maryland workers compensation attorney.  A workers compensation attorney can take steps to force the insurer to pay for your medical treatment.  A hearing can be requested before the Maryland Workers Compensation Commission to fight for the treatment you deserve and any other benefits that you may have gone without thus far.  Maryland workers compensation attorneys are paid out of money that they recover for you- on a contingency basis.  In the event a hearing takes place solely because medical treatment was denied by workers comp the attorney does not request a fee!

 

SLOW MEDICAL TREATMENT IN WORKERS COMP CASES        

Delayed medical treatment in Maryland workers compensation cases is unfortunately a regular occurrence.  While there is no fair explanation for the delays in medical treatment in workers comp cases there is an explanation which includes the procedural restrains of the legal system itself and conflicting legal rights of the injured workers and the insurance companies.  While delays in medical treatment in workers comp cases is sometimes unavoidable there are some practical steps to take to minimize the chance of delaying medical treatment in your workers comp case.  It is important to understand that delays in treatment are not the same medical treatment denied by workers comp.

In some cases there are extensive and repetitive delays in obtaining medical treatment through workers compensation insurance.  The delayed medical treatment may arise because of the Employer and Insurer’s rights which may inadvertently place the injured workers rights on hold.  Like the injured, the Employer/Insurer have certain rights under Maryland’s workers compensation laws.

Independent Medical Evaluations may delay medical treatment in workers comp or they may lead to denied medical treatment in workers comp

If your medical treatment or doctors appointments have been put on hold so that workers comp can schedule an Independent Medical Evaluation with their doctor you should not wait to take action.  Workers Comp may delay or deny medical treatment so they can obtain a Second Opinion or Independent Medical Evaluation (IME)

The Employer/Insurer does not legally have to accept the treating physicians recommendation whether it be for surgery, injections, pain medication, physical therapy or other treatment.  They are entitled to obtain an Independent Medical Evaluation (IME) from a doctor of their choosing before willingly paying for the treating physicians recommendation which results in a treatment delay.  Under Maryland workmans comp laws the treatment must be “reasonable, necessary, and causally related” to the accident at work.  This phrase opens up a door to differing opinions and creates the proverbial gray area which provides both the injured worker and workers comp argument leverage over the medical treatment and whether it is related to the actual work incident.  What is reasonable to Doctor X may not be reasonable to Dr. Y and what is necessary to Dr. X may not be necessary to Dr. Y.  Also, Dr. X and Dr. Y can disagree as to what is causally related to the accident.

When an IME is scheduled it is time to obtain a Maryland workers compensation attorney.

More often then not, the delays in treatment are related to the workers comp Insurer’s right to have an IME performed.  The workers comp adjuster will wait until he or she receives the IME report before approving the treatment recommended.  In some cases the medical treatment denied by workers comp may be approved after an IME.  IME’s are often scheduled a month or two out and the medical reports can take another few weeks to be issued.  If this delay in medical treatment is not aggravating enough in the event the IME Doctor indicates that the medical treatment is not reasonable, is not necessary, is not causally related, or any combination of these requirements then the delay in treatment continues.  When the adjuster denies treatment, or if it is expected medical treatment is to be denied by workers comp once the IME is performed, a hearing before the Maryland Workers Compensation Commission will need to be requested.  Unfortunately hearings are not held as soon as everyone in the workers compensation community would like and this will again delay the treatment and the conclusion of the case.

It is important to realize that in many Maryland Workman’s Compensation cases there are numerous IME’s performed which may lead to numerous delays.  It is not uncommon for an IME to be scheduled and performed based on the reasonableness of some form of treatment recommendation like physical therapy, and soon after a second IME is being performed to determine if another form of treatment is reasonable like an MRI.  It is important to know what to expect at the IME.

 

Workers Compensation Attorney Andrew M. Rodabaugh Esq. has been getting medical treatment authorized for injured workers for years!

For a FREE consultation   Call Click to email  or just fill out the form below and Mr. Rodabaugh will contact you!

 

Legal procedures may lead to delays in workers compensation medical treatment

Once a hearing request is filed with the Maryland Workers Compensation Commission the legal process of seeking authorization for the denied medical treatment begins.  Sometimes this is referred to as appealing the adjuster. (See the appeal process)  The waiting period fluctuates for the workers compensation hearing but typically hearings are set-with in three months ultimately delaying medical treatment further.  The reasons for the waiting period are comparable to the reasons one must wait for any Government agency or department to act. Often referencing bureaucratic restrictions, budgetary restraint, or excess citizen demand.  Occasionally the hearings can be placed on a docket longer than three months, and seldom within one month.  Assuming it took two months for the IME to be performed and another three months for the hearing before the Maryland workers compensation commission, the injured employee could expect to wait five months for a determination of whether the work comp insurer will be responsible to pay for the medical treatment.  It is best not to assume a five month wait and prepare for a longer period.

Legal delays can also materialize if there is a need for a postponement or continuance of the scheduled hearing.  When the case is continued the hearing will typically be reset within two months however occasionally it is sooner.  The basis of a qualifying continuance request are numerous and can arise from any party involved in the case including potential witnesses, attorney’s, or, very rarely the Workers Comp Commission.

Can you avoid delays of medical treatment in workers compensation cases?

Each and every workers compensation case is different in almost every regard but especially when dealing with the consistency of medical treatment.  On occasion there are injured workers that never have to deal with delays in medical treatment in their workers compensation case.  However, most do have some sort of hang up with obtaining authorization for a consultation with a physician or a medical procedure with a provider.  To expedite medical treatment authorization it is helpful to be pro-active.  Do not assume the doctors office is requesting approval from the adjuster.  Don’t assume the doctor’s office properly requested authorization for medical treatment from the workers compensation adjuster.  It is a good idea to follow up on treatment requests even if there is a nurse case manager assigned to the case or the treating provider has indicated they have requested authorization.  Delayed medical treatment in workers compensation cases can be minimized if all parties are pro-active.

In the event an IME is scheduled it is highly unlikely medical treatment will be authorized before the scheduled evaluation.  An option is to discuss treatment approval through a health insurer rather than the workers comp insurer.  When requesting treatment from a health insurance policy it is important the health insurance company is aware that there is a pending workers compensation case with an IME scheduled.  Using health insurance to avoid delays in medical treatment in a workers comp case is something that should be discussed with a qualified attorney because of the potential out of pocket expenses, issues with reimbursement, and other potential problems.

In rare circumstances when workers comp delays medical treatment the injured employee is willing to pay out of pocket for the medical treatment. Rather than wait for an IME to be performed or for a hearing to take place the injured worker may pay out of pocket if financially doable and permissible according to the doctors office policy.  Injured workers should take care to pay for medical treatment according to the workers compensation fee schedule rather than health insurance rates or the doctors billing rates.

 

Workers Comp wont pay & Health Insurance wont pay. Work Injury Maryland

The great dilemma! Neither workers comp nor health insurance will pay for treatment.

The situation is all too familiar to the Maryland workers compensation attorney.  The dilemma arises when an employee is injured on the job and is, by law, required to use workers comp insurance to pay for his or her medical treatment.  From the first doctors appointment the medical providers are required by law to bill workers comp.  Because of this, the health insurer will often refused to pay for any treatment.  In many workers comp cases the initial treatment get authorized and paid for by workers comp and things run seemingly smooth.  Then workers comp decides to start denying treatment.

Ordinarily the treatment that workers comp will deny is surgery, diagnostics, or extensive physical therapy.  As a natural reaction to workers comp denying treatment, the injured worker contacts his or her health insurance and requests they authorize the particular treatment sought.  The health insurance response: “its a workers comp case.”

What to do when Workers Comp won’t pay and Health Insurance won’t pay for medical treatment

Pay out of Pocket?

It is at this point the injured worker begins to feel helpless, devastated, angry, or confused.  The next thought is to try and pay out of pocket so that they can get the treatment needed, get better, and return to work.    This is a very noble thought and those that think of this should be commended for attempting to do what seems best.  The unfortunate reality is that many physicians refuse to accept cash payments now days.  The reasoning I can not comment on, however it does seem, especially with more expensive treatment, that there is a common refusal to accept cash payments.

Another issue with payment in cash could arise.  The injured may believe that they can pay cash for the treatment and get reimbursed by either workers comp or health insurance eventually.  In a great majority of cases this will not happen.  Workers comp insurance pays physicians according to a fee schedule.  Health insurance pays physicians according to a fee schedule.  This means that the insurance providers, bother workers comp and health insurance, will pay at a lower rate than what is actually billed by the medical provider.  That is a per-determined rate and not subject to increase.  The amount the injured worker pays in cash, if permitted, will be at the full service rate and not the fee schedule rate.  If any reimbursement is obtained it may be substantially lower than what was paid out of pocket.

Do I lawyer up to get health insurance or workers comp to pay for the treatment?

This is a good idea.  If neither workers comp nor health insurance will pay for your treatment in Maryland then a workers compensation attorney can help get the treatment paid for.  The good news is even if the Maryland work injury lawyer loses the workers comp case health insurance will then be responsible to pay for the treatment.  An “Order” of the Maryland workers compensation commission will be issued finding the treatment either related to the work accident, or not related to the work accident.  If the lawyer wins your case then Workers Comp will be forced to pay!  Even in the unfortunate instance your case is lost at the Maryland Workers Compensation Commission health insurance will be required to pay for the treatment.

 

See What workers comp can deny!

 

I needed a lawyer for my workers compensation case. I was referred to Mr. Rodabaugh. I was very nervous about the case, and a little overwhelmed. Mr. Rodabaugh took extra time to talk to me (lots of questions he answered over the phone) and explained step by step of how everything worked. He was very confident, and made me feel comfortable with my case and decision. I highly recommend Mr. Rodabaugh.
  • Five Stars
L.F.Technician

 

You can speak with Baltimore workers compensation lawyer Andrew M. Rodabaugh for a FREE consultation   Call Click to email  or just fill out the form below and Mr. Rodabaugh will contact you!

 

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Summary
Maryland Workers Compensation Attorney & Personal Injury Attorney
Service Type
Maryland Workers Compensation Attorney & Personal Injury Attorney
Provider Name
Andrew M. Rodabaugh Esquire,
baltimore,Maryland,Maryland-
Area
Maryland
Description
Baltimore Workers Compensation Attorney Andrew M. Rodabaugh can help obtain medical treatment that has been denied or delayed by workers comp. Injury victims should not have to wait for needed treatment!