Will My Medical Bills Be Paid in Workers’ Compensation?

A question that has been asked for me to answer is the question of Will My Medical Bills Be Paid. There are several IFS to this question.

If it was authorized…

If the Medical bill is for treatment that was prescribed from a doctor that has been authorized by your insurance company and your injury claim to treat you than yes it will be covered by the insurance company. This is assuming that they have been authorized to provide the treatment.

If it was not authorized…

If they choose to provide the treatment without the authorization it will be my position at least, that the doctor or the provider took that risk onto themselves and that is not the injured worker’s problem. The injured worker does not have to worry about paying for that doctor if he does not get payed because he did not get authorization to provide that treatment in the first place.

Denials of Treatment…

Another thing that needs to be taken under consideration is that there are frequently denials of treatment that are requested by treating doctors here in California. It is an ongoing and continuing problem. I can’t tell you how much time we must spend on this. It is not a good thing for the injured worker to be waiting long periods of time to get their treatment. It is a heavy burden for them and their lawyers.

The truth…

The truth of the matter is that you use these doctors that never see you to review your medical. They then check to see if your doctors have justified the request for the treatment. It is tedious process and takes a lot of time. Frankly these doctors are not willing to take the time that it takes to justify the request for treatment, so this is why it gets denied. This usually causes the injured worker to get upset and causes them to come to our office.

We try to explain that it really starts and ends with their doctors. If the doctor can’t provide good justification for their request for authorization, then it is not going to get authorized. Assuming that the Utilization Review is done on a timely basis, which must be done within 5 business days, their denial is going to be upheld and there is nothing I can do about it. I regret telling you this, but I have fought this battle many times and this is where we currently stand in October 2018 in California with getting Medical treatment.

Overall

Getting Medical Treatment in Workers’ Compensation is a long and necessary process. This is why it is recommended to partner with an attorney, so you won’t go through this long process yourself. Our law office is always here to provide you with years of experience and a kind and friendly staff.

NOTICE: Making a false or fraudulent Workers Compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.