The insurance company has control of your medical treatment for the first 30 days following an industrial injury. This means that you are required to go to the doctor they select. However, after the 30 days has expired you can designate one primary treating physician of your own choosing to continue your medical care. This primary treating physician may refer you to other specialists for treatment, but all work status, etc. will be controlled by the primary doctor. This means that you cannot go to other doctors for treatment without specific referral from your primary doctor.
Generally, on an accepted claim the insurance has 7 days from the date of a request for authorization of treatment to either authorize the treatment or deny it. This deadline is not set in stone and can be extended for various reasons. Treatment can be denied due to several factors, the most common is that the insurance carrier’s medical review does not find that the treatment recommended is reasonable and necessary. As such a term is subjective in nature, the carrier is given wide latitude to make these determinations.
If a specific treatment is denied, there are a few options. First, you can proceed with the treatment through your private health insurance policy if one is available and then your insurance carrier will likely file a lien against your claim for payment when your case resolves. Another option is to proceed with the treatment on a lien basis directly with the medical provider. In such cases, the medical provider agrees to wait for payment until the end of your claim.
The final option is to request a hearing before the Workers’ Compensation Appeals Board. However, as the courts are extremely understaffed and overworked at this time, it is best to limit filing such a hearing request to only the most urgent of situations.
There was excellent communication. If I didn’t understand something, Adam explained it. I was informed of what to be expected as the case was moving along. Very satisfied with the service.
I am very pleased with the services provided by Mehlhop & Vogt. The firm knows what they are doing and gets stuff done! I always felt respected and cared for. Adam always answered my questions right away and with great detail.
I liked the way Mr. Mehlhop handled my case, he was very professional at all times. I feel like he did the best he could considering my wages.