If you have been involved in a work injury in Maryland there is a chance that getting treatment authorized may be difficult from the very beginning of the case.
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The good news is that ordinarily the initial medical consultation will be paid for by workers comp. Further, in the event of a catastrophic accident continued treatment will be authorized for a while.
It is ordinarily those injuries that are not immediately noticeable that fall under scrutiny by the workers comp adjuster. Especially in cases involving ligament or soft tissue damages there may be delays in authorization of the medical treatment. The adjuster may approve an initial visit but when further treatment is ordered such as physical therapy, injections, or surgery authorization may become difficult to ascertain.
Why are there delays in treatment authorization under Maryland Workers Compensation cases?
Failure to communicate
A very common cause of delays in obtaining treatment authorization is simply a breakdown in communication. A good majority of workers comp adjusters are overworked and are not able to timely respond to treatment requests. Weeks can go buy without a return phone call or communication of any kind. This is not acceptable and it may be necessary for the injured worker to obtain a Maryland Workers Compensation Attorney in order to move the case forward. If the adjuster is intentionally refusing to communicate that may be an indication there will be further delays.
Prior to approving treatment the workers comp insurer is entitled to obtain a second opinion or Independent Medical Evaluation (IME). If the adjuster is planning on scheduling an IME or has already scheduled an IME treatment may be delayed until after the IME report is obtained. Most of the time these IME opinions come from a select few doctors in the state of Maryland who have limited availability for appointments. This means that the IME may be scheduled out a month or more in the future. If the IME opinion indicates no treatment is necessary the adjuster will deny treatment. It is at this point that a Maryland Workers Compensation Attorney should be involved. The injured worker may have to wait months for a hearing and subsequent decision by the Workers Compensation Commission.
Necessary documentation may be required
Most authorizations for medical treatment will only come after the medical records are obtained and reviewed by the assigned case manager. Adjusters will require the medical report which prescribes the treatment so that they can review and ensure the treatment being prescribed is related to the accident at work. While this on its face does not seem like much of an obstacle some medical reports are not generated immediately and may take sometime before they become available.
Medical Expenses are increasing
If the treatment being recommended is getting increasingly costly the case manager may be starting to “adjuster” the file. It is the workers compensation adjusters job to keep costs down. If denying continued physical therapy or surgery will potentially reduce costs then that is precisely what the adjuster will do.
If you have been injured on the job in Maryland and are having a difficult time obtaining authorization for medical treatment then contact Maryland workers compensation attorney Andrew M. Rodabaugh for a free consultation and discuss your options moving forward.