One of the benefits of workers' compensation is medical care. Your employer's insurance company is responsible for covering medical bills that resulted from the on-the-job accident you experienced. Unfortunately, it is not uncommon for an insurance company to deny certain medical procedures to claimants. If the insurance company has denied your doctor's request for a procedure, here is what you need to know.
Why Was the Request Denied?
Why your doctor's request for a medical procedure is denied plays a major role in determining whether or not you have a legal option for fighting the insurance company. Part of assessing the denial reason is determining if the insurance company was acting in good or bad faith.
If the insurance company was acting in good faith, there was a good reason for denying the procedure. For instance, if the doctor submitted the wrong paperwork to request the procedure, the insurance company's denial would be considered an appropriate response.
However, if the insurance company denied you care even though the doctor completed the paperwork correctly and deemed the procedure medically necessary, you could argue that the insurer was acting in bad faith.
What Can You Do?
If the insurer was acting in good faith, you still have legal options available to you. Contact the insurance company and find out the exact reasoning for the denial. The company is legally required to provide you with a detailed explanation. If the issue is easily resolvable, such as a clerical error, you and your doctor can make corrections to the request and resubmit it.
However, if the insurance company does not have a sound reason for the rejection, you can start by appealing the decision. The denial letter that you receive from the insurer should include instructions for filing an appeal. Your doctor might have to write a letter on your behalf detailing why the procedure is necessary for your recovery.
If the insurance company continues to deny your request, you can opt to file a lawsuit against the insurer to recover monetary compensation that can be applied towards the medical bills. You also have the option of using your own health insurance to cover the bills. If you do, your attorney can attempt to negotiate with the insurance company to reduce any repayments that you will have to make.
To decrease the chances that an insurer will deny a medical procedure, work with an experienced workers' compensation attorney.
Share16 March 2017
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