The workers’ compensation system gives the right to an injured worker to claim medical treatment from their employer or the insurance company.
However, there could be some situations in which the insurance company simply refuses to provide medical treatment to the injured employee. It may also happen that the insurance company may discontinue the medical treatment of the injured employee. Kansas City Missouri workers compensation lawyers suggest that denial of treatment by the insurance company is not the end of the road. The employee should understand that receiving appropriate medical treatment for the work-related injury is their right, and they can appeal in the workers’ compensation system against the denial of medical treatment.
Reasons Why Medical Treatment is Denied
An insurance company may refuse or discontinue medical treatment of an employee for any one of the following reasons:
- The insurance company may refuse medical treatment if they are denying workers compensation, because they believe that the injury is not work-related, it does not meet the criteria of “accident”, or the worker failed to report his injury in time.
- The insurance company may also refuse medical treatment if they believe that the injury is not work-related but the result of a pre-existing condition.
- Another common reason why insurance companies discontinue medical treatment of an injured employee is when they feel that treatment is no longer necessary, or that the employee has reached maximum possible improvement and further treatment will not lead to any improvement in the condition.
- The insurance company may also discontinue medical treatment if they believe the employee has been non-compliant or has abandoned the treatment by missing appointments.
Clear Communication Essential
The employee should demand a written explanation for the denial or discontinuation of medical treatment. Attorneys have come across numerous cases where the injured employee was refused medical treatment just because of delays in communication or incomplete information. Clear communication with the insurance company can resolve the problem in such cases, and the injured employee may get medical treatment.
Appealing the Denial
However, even after furnishing correct information and communicating with the insurance company, if they refuse to provide medical treatment, the injured employee can request an evidentiary hearing before an administrative law judge. The injured employee will be required to gather and produce all medical records and evidence in support of their workers’ compensation claim, and the judge will decide whether the claim is justified.
Kansas City Missouri workers compensation lawyers inform us that if the insurance company has refused medical treatment, the injured employee can seek treatment from a physician of his choice. Then during an evidentiary hearing before the administrative law judge, the employee can request compensation for the medical expenses. Consult with The Law Office of James M. Hoffmann at (816) 399-3706.