We’ve spent more than 30 years representing injured workers, helping them address delayed or denied medical treatment.
If you’ve been hurt at work in Missouri, you may expect medical treatment to begin quickly. But many injured workers discover that important care—like MRIs, specialist referrals, or surgery—can take weeks or even months to get approved.
These delays are one of the most frustrating parts of the workers’ compensation process. Understanding why they happen and what you can do about them can help you protect both your health and claim.
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Missouri Workers’ Compensation Insurance Controls Medical Treatment
Under the Missouri workers’ compensation law, the employer or its insurance company usually has the right to choose the treating doctor and approve medical care.
This means the insurer typically must authorize:
- Diagnostic tests (MRIs, CT scans, nerve studies)
- Specialist referrals
- Physical therapy
- Pain management treatment
- Surgical procedures
Until that authorization is granted, the treatment may not move forward. In many cases, delays occur because the insurance company is reviewing or questioning the medical recommendation.
Common Reasons Workers’ Comp Delays MRIs or Surgery
While every case is different, certain patterns appear frequently in Missouri workers’ compensation claims.
1. The Insurance Company Wants “Conservative Treatment” First
Insurers often require less invasive treatment before approving advanced diagnostics or surgery.
For example, they may insist on:
- Physical therapy
- Medication
- Rest or modified work duties
If these approaches do not improve your condition, your doctor may request additional tests, such as an MRI.
2. The Adjuster Questions Whether the Injury Is Work-Related
Sometimes the insurance company delays care while it investigates whether the injury actually occurred at work.
They may review:
- Accident reports
- Medical records
- Witness statements
- Prior injuries
If they suspect a pre-existing condition or dispute how the injury occurred, they may delay approving tests until the investigation is complete.
3. Requests Must Go Through Utilization Review
Many insurance companies use a process called utilization review, where a third-party doctor evaluates whether the requested treatment is “medically necessary.”
This process can slow things down because:
- Records must be submitted
- A reviewing physician evaluates the request
- The insurer decides whether to approve or deny it
Even when the treating doctor recommends treatment, the insurance reviewer may disagree, leading to delays or denials.
4. The Insurance Company Orders an IME
In some cases, the insurer schedules an Independent Medical Examination (IME) before approving surgery or other expensive treatment.
The IME doctor may evaluate:
- Whether the injury is work-related
- Whether the recommended treatment is necessary
- Whether the worker has reached Maximum Medical Improvement (MMI)
This step can significantly delay care.
5. Cost Control
Workers’ compensation insurers are businesses. Expensive treatments—such as surgery or advanced imaging—may trigger additional review due to their cost. Unfortunately, this can result in injured workers waiting longer for treatment that their doctor believes is necessary.
What You Can Do if Your Medical Treatment Is Being Delayed
If your workers’ comp treatment is stalled, there are several steps that may help protect your claim.
Document Everything
Keep records of:
- Doctor recommendations
- Missed or delayed appointments
- Communication with your employer or insurance company
- Work restrictions and symptoms
This information can become important evidence if your claim is disputed.
Talk Directly With a St. Louis Workers’ Compensation Lawyer
If your workers’ comp claim is being delayed or you are struggling to get approval for tests, MRIs, or surgery, it may help to speak with a lawyer who focuses on Missouri workers’ compensation cases.
At the Law Office of James M. Hoffmann, injured workers work directly with Attorney James Hoffmann, not a call center or junior associate.