What should you do if the insurance company won’t pay for the recommended medical care?
This article discusses your rights as an injured worker and what you can do if the insurance company does not cooperate. If you are having trouble getting the insurance to cover the care you need, don’t hesitate to contact The Law Office of James. M. Hoffman for help!
Reason for Denial
There are many reasons why the insurance company may deny payment for care. Some common reasons include:
- The service or treatment is not covered under your employer’s plan
- You have exceeded your employer’s coverage limits
- The service or treatment is considered experimental or investigational
- The provider is not in your employer’s plan’s network
- You have not met the conditions of your employer’s policy; for example, you have not fulfilled the waiting period
What Are My Rights as an Injured Worker?
As an injured worker, you have several rights that protect you when dealing with the insurance company. These generally include:
Right to Receive Information About Your Employer’s Workers’ Comp Plan
This includes a description of your rights and responsibilities under the plan.
Right to Appeal
If you are denied coverage for a service or treatment, you have the right to appeal the decision. This process allows you to present your case to an appeals board or court and plead your case for why the care should be covered.
Right to Seek Treatment
You generally have the right to seek treatment from any provider you choose within the limits of your employer’s plan. This means that you can go to any doctor or hospital that accepts your employer’s workers’ comp insurance coverage.
Right to File a Complaint
If you are not satisfied with the service or care you received from your employer’s insurer, you have the right to file a complaint. This will allow you to voice your concerns and hopefully get them resolved.
What Can I Do if the Insurance Company Denies Payment for Care?
If the insurance company denies payment for care, it is generally best to discuss your options with an experienced St. Louis work injury lawyer to ensure your legal rights are protected.
At the Law Office of James M. Hoffmann we have over 30 years of experience protecting the rights of injured Missouri workers and can work with you to help you understand your rights and what steps you can take to get the care you need.
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