medical treatment

In some cases, the insurance company may deny certain procedures or treatments after a work-related injury.

Worker’s compensation is supposed to cover all medical costs that relate to your work injury or illness. However, in some cases, the insurance company may deny certain procedures or treatments.

Can they do that? What would be the reason?

Can the Insurance Company Deny Treatment?

This is a difficult question to answer, as it works on a case by case basis. Technically, the insurance company should have no say in your treatment. The only one who can decide which treatment or procedure you need is your worker’s comp doctor.

Still, how are they able to deny something your doctor deems is relevant to your treatment? Well, it, unfortunately, boils down to cost. The insurance company may refuse to pay to a particular treatment if they deem is either unnecessary or if there is an alternative, cheaper procedure that would bring the same results.

How Would They Know?

The insurance company adjuster may not have any medical expertise to know what is and isn’t a relevant procedure for injured workers, but they do collaborate with medical experts. So, they could present your case to one of the said experts and ask for their opinion, especially in regards to more expensive procedures such as surgery.

If their experts deem you do not need said surgery, since there are other forms of treatment available (that would also cost less), the insurance company will use their opinion as an argument your surgery is unnecessary, even if your worker’s comp doctor thinks otherwise.

What Can You Do?

Medicine is often not a black and white industry, and it is possible for 3 doctors to have 3 different recommendations for the same case. However, in the context of workers’ comp claim, you want to ensure you are getting the best medical care possible, even if the insurance company believes it is too expensive.

So, if your surgery is denied, does that mean it’s the end of the road? Not exactly. For one thing, your worker’s comp doctor may revise your course of treatment to stay within the lines of what the insurance company wants, but that’s not exactly ideal, since you may actually benefit more from the surgery than its alternative.

The safest way to proceed in these instances is to reach out to a St. Louis worker’s compensation attorney for help. They can help make your case and bring additional evidence to showcase the surgery is your best course of treatment, possibly even by bringing in other medical experts to make this case on your behalf.

Even if they cannot reach an agreement easily, they still have additional legal options, such as initiating a mediation process or even taking your case in front of an administrative judge.

St. Louis Work Injury Lawyer

Don’t get discouraged if your surgery gets denied. Reach out to an experienced work injury lawyer today to learn more about your legal rights and ensure they are protected.

Workers’ compensation laws are in place to make sure that Missouri injured workers can access life-saving medical treatment when needed. But what happens when access is reduced?

This global health crisis, unfortunately, leaves many injured workers on the sidelines waiting to find out if they are able to see a doctor or not, as many consultations or procedures have been delayed, in hopes to flatten the curve.

How to See a Doctor Even in Difficult Times

This is one of the many moments where working with an experienced St. Louis worker’s compensation lawyer really makes a difference. An experienced attorney doesn’t just have a good grasp on the law – they also have a lot of contacts, specifically contacts from the medical field. As a result, they may be able to recommend a good doctor who knows how to treat your particular condition and even see you during these difficult times.

As a result, you may be able to continue your treatment as needed, instead of simply waiting until things cool down. Plus, they can help with laws specific to Missouri when it comes to workers’ comp.

You Cannot Technically Choose Your Own Doctor

In Missouri, your employer has the right to choose who will be treating you during your worker’s comp case. Usually, they leave this decision to the insurance company since they have a lot more connections in this area. However, when you’re faced with a difficult time like the present, the insurance company may not know a doctor who is able to treat you, in which case they may try to postpone your case until they do.

This is where your lawyer can step in again and argue in your favor. They can build a strong case that shows you (a) cannot afford to sit around and wait until the company eventually finds a doctor to treat you, and (b) should accept a different doctor to do it, even if they’ve not worked with them before.

Even if you’re not choosing your own doctor, you still have the right to high-quality care. The insurance company can sometimes forget this and base their choice in physician on criteria like who they have an established rapport with. Your attorney can ensure you that you receive the quality care you are entitled to.

Speak With an Attorney ASAP

If you’ve been injured on the job, a global crisis or lack of access to a doctor should not stop you from getting the best medical care possible. However, in a situation where the party deciding who treats you doesn’t necessarily have your best interest in mind, it becomes essential to work with someone who does. Reach out to a qualified St. Louis worker’s comp attorney right away to make sure your legal rights are protected and you are given the best possible care.

Missouri workers who are injured soon discover a string attached to their worker’s comp case: they are unable to choose their doctor.

According to state laws, your employer has the right to choose the doctor who will be treating your worker’s comp injury. In reality, your employer will likely not concern themselves with this decision and let the insurance company decide instead. This can lead to some awkward situation, especially if you notice your worker’s comp doctor isn’t helping you.

What then?

You Should Not Experience a Difference in the Quality of Care

Though the insurance company (or your employer) will choose the doctor treating your worker’s comp injury, they have no say in your medical treatment.

The insurance company prefers to choose the doctor because they have a relationship previously established with them, meaning they know the sort of treatments and medication they use, trust them and can handle the reimbursements a lot easier. In all honesty, dealing with a new doctor can take up a lot more time for them.

What If Your Doctor Isn’t Helping You? What Are Your Options?

Unfortunately, some doctors may provide sub-par care, or even treat their patients poorly. But when you are on worker’s comp, it may be more difficult to switch doctors while also retaining the benefits.

One option you have is to honestly speak to your employer about your situation, and tell them your doctor is not offering you adequate services. Your boss may be empathetic to your situation and allow you to switch to a new doctor, even if the insurance company may prefer that you don’t.

By far, the best option you have is to get in touch with a St. Louis worker’s compensation attorney to see what you can do based on your particular situation. It’s possible, with a help of a lawyer, to even get a second opinion on your medical cases, which can provide enough evidence to show your worker’s comp doctor was not offering the best care. In this instance, the insurance company can’t push back on your request to change doctors.

Additionally, if you have been treated poorly, you may also be entitled to seek compensation for medical malpractice, if your care resulted in additional injuries or worsened condition.

Speak With an Experienced Attorney in Missouri

If your worker’s comp doctor isn’t providing you with the best care, or you suspect your treatment is being influenced by the insurance company, please reach out to a St. Louis worker’s comp attorney right away.

With the help of a lawyer, you may be able to switch your worker’s comp doctors while still retaining your compensation benefits. Do not seek a different doctor on your own, as this may result in all your benefits stopping, and it may prove difficult to get them back.